JOHN B. HAWES, 2d, M. D.
SMALL, MAYNARD & COMPANY
EDNA L FOLEY
^Presented to the
Hartford Hospital School of Nursing
in memory of
Martha J. Wilkinson, Class of 1890
Hartford's first visiting nurse
by her friend
Edna L. Foley, Class of 1904
WHAT IT IS AND WHAT
TO DO ABOUT IT
JOHN B. HAWES, 2nd, M.D.
Instructor in Medicine Harvard Medical School, Director
Tuberculosis Clinic, Assistant Visiting Physician
Massachusetts General Hospital, Secretary Massa-
chusetts Tuberculosis Commission
SMALL, MAYNARD AND COMPANY
By Small, Maynard & Company
I fully realize that there are already many books,
large and small, that are intended to give the gen-
eral public some definite knowledge on the subject
of tuberculosis. My only criticism of many of
these books is that they are either so short that cer-
tain important practical details are omitted and thus
present only a summary of the subject, or else they
are so long and so replete with historical informa-
tion and scientific discussion, that they defeat their
own purpose. I have tried to make the present vol-
ume a mean between these two extremes.
This book is in no way intended to take the place
of a physician, but to be of service to him, to the
patient, and the patient's family. The busy practi-
tioner cannot be expected to have more than a gen-
eral idea as to the cost of living at Saranac Lake,
for instance, and how to get there. Such informa-
tion and other of like nature I have included in this
book. My hope is that it will prove of value.
John B. Hawes, 2nd.
I What Consumption is and What it Does . . g
II How Germs of Tuberculosis Get Into the Body 12
III Bovine Tuberculosis 15
IV Early and Important Symptoms of Pulmonary
V What to do if you Think you may have Con-
VI What to do if you are Told and Know that
you have Consumption 22
VII Home Treatment 25
VIII How to Llve and Sleep in the Open Air. By
Thomas Spees Carrington, M.D 28
IX Treatment in a Local or not far Distant San-
atorium. HOW TO GET THERE AND WHAT IT
X Saranac Lake. Where it is, what it Offers
to the Consumptive, and how to get there 50
XI Colorado and the West 55
XII After the Sanatorium, then What? ... 57
XIII Tuberculosis in Childhood 60
XIV How Parents can Help in the Prevention and
Cure of Tuberculosis in Children .... 62
XV Fresh Air Rooms and Open Air Schools.
What They are and What They are for 65
XVI Consumption and Marriage. What should
Consumptive Parents do about Their Chil-
XVII The Problems of Paying the Bills in Con-
sumption, and How They have been Solved 71
XVIII Drugs and Cures for Consumption; Their
Use and Abuse 76
XIX Diet in Consumption 78
XX How to Keep from Giving Consumption to
XXI General Remarks 85
XXII Hints and Helps for Tuberculosis Patients.
By Charles E. Minor, M.D 90
WHAT CONSUMPTION IS AND WHAT IT DOES
Tuberculosis is a disease caused by a germ or
tiny plant called the tubercle bacillus. This germ
enters the body usually by way of the mouth and
goes to the lungs, or elsewhere and then grows and
causes the disease tuberculosis. When the disease
is in the lungs it is known as pulmonary tubercu-
losis, consumption, or phthisis. The germ may go
to any part of the body and there cause disease.
Pott's Disease or tuberculosis of the spine or hump-
back; hip disease, white swelling of the knee or
ankle; lupus, tuberculosis of the skin, scrofula, tu-
berculosis of glands, and tuberculosis of the spe-
cial organs, such as the eye, ear, nose, throat,
kidneys, etc., are all manifestations of this disease.
No matter where located, tuberculosis is always the
same and due to the same cause.
The disease is a very ancient one. Traces of it
have been found in Egyptian mummies ; it was well
known to Greek, Arabian and Roman doctors,
philosophers and historians. Up to comparatively
recent times, it was considered an absolutely in-
curable disease, and not until the early part of the
last century did it begin to be realized that con-
sumption could be cured. The modern sanatorium
movement, by which tuberculosis is treated by sun-
shine, fresh air, good food and rest, began in the
Black Forest in Germany and from there has spread
all over the world.
The exact cause of the disease was not discov-
ered until 1884, when Robert Koch of Berlin iden-
tified and isolated the tubercle bacillus. This was
a great step in advance, in that it enabled us to
carry on the fight intelligently. Since that time
the campaign against consumption has aimed to
accomplish two things; first, to destroy the germ
which causes the disease and to prevent its entrance
into the body in every way possible; and, second,
to teach people how to live so that they will be
strong, healthy, and, by their own vital forces,
able to ward off tuberculosis and other diseases.
On these two great principles rests the entire anti-
It is unnecessary to mention, except in the most
general way, the importance of this campaign
against consumption. In the United States alone
over 200,000 people die of it every year, while in
the world over 1,000,000 inhabitants annually suc-
cumb to this disease. Compared with tuberculosis,
the acute infectious diseases of childhood sink into
insignificance, and even those much dreaded dis-
eases, small-pox, yellow fever, leprosy, and even
cancer, do infinitely less harm and kill a vastly
smaller number of people.
WHAT CONSUMPTION IS n
In order to combat such a plague as this, and
such an insidious enemy, it is essential for every
one to have some plain and definite information
about the disease, how to keep from getting it, how
to cure it, and how to keep from giving it to others.
HOW GERMS OF TUBERCULOSIS GET INTO THE BODY
Tuberculosis, or consumption, is primarily a
home or house disease. This means that it is trans-
mitted from one person to another in the early years
of life in the intimate contact of the home. In
the majority of instances, when a person gets con-
sumption, it means that some one has been either ig-
norant or careless, or both. The disease is spread
by means of the sputum. As the process develops
in the lungs, the germs grow and multiply, and the
lung tissue is destroyed. This broken down lung
substance, often containing millions of tubercle
bacilli, is raised by coughing and discharged as spit
or sputum. Thus the great majority of cases of
consumption comes from other cases. The sputum
which the careless consumptive spits out on the
floor, sidewalk, or elsewhere, dries, is ground up into
dust and may be breathed in by some young child
who thus becomes infected with the disease. In-
fection may take place by direct inhalation, in which
case the germs are breathed directly into the lungs,
or the germs may lodge in the mouth or throat and
thence be carried by food or saliva into the stomach
and from there into the lungs or, finally, the germs
GERMS OF TUBERCULOSIS 13
may be taken up by the lymph vessels and by this
means carried eventually to the lungs. The exact
path of infection is not so important to bear in mind
as the fact that the germs almost always get into the
body through the mouth.
Tuberculous infection is the rule rather than the
exception, but there is a vast difference between tu-
berculous infection and tuberculous disease. Tu-
berculous infection means that somewhere in one's
body, usually in the lymph glands, there are some
germs of tuberculosis which, however, may do no
harm in any w T ay. It has been proved beyond doubt
that almost every adult has germs of tuberculosis
somewhere in his body, and that by the time nearly
every child reaches his fifteenth year, he has been in-
fected with this organism. The fact that most of
us are well and strong and that we are quite una-
ware of the presence of this most unwelcome visitor
is the best evidence we have of the curability of this
Tuberculous disease is of course quite a different
thing. This means that in some way or other, be-
cause of inherited weakness, bad habits, bad living
conditions, etc., the system has been weakened and
the powers of resistance lessened so that the germs
of tuberculosis grow and multiply and produce
symptoms. When this happens it is an indication
that the tuberculous infection, usually already pres-
ent, has changed into tuberculous disease.
Whether or not active tuberculosis or consump-
tion develops in the body depends, therefore, on va-
rious factors. It is, for instance, comparatively
rare in persons over sixty years and under fourteen
or fifteen years. Thus the age is important. The
disease usually develops between the ages of 15 and
35 years. Again, much depends on the physical
condition. A constitution weakened either from in-
herited tendencies or from overwork or disease falls
an easy prey to tuberculosis. The length and inti-
macy of exposure is a third most important factor
in tuberculous infection. We are most of us able
to cope with a small number of such germs even for
a long time, or a fairly large number at once, but
even the strongest and healthiest of us cannot with-
stand the continued invasion of our bodies by large
numbers of germs. Thus, whether or not tubercu-
lous infection becomes tuberculous disease depends
in large measure on the length and intimacy of ex-
posure to the outside source of contagion.
It is important to remember, therefore, first, that
it is practically impossible to escape entirely these
omnipresent germs of tuberculosis, but that, if we
keep our bodies strong and well, we need not worry
about contracting this disease, and, second, that any-
thing which tends to lower our vital forces and bod-
ily resistance, such as alcohol, overwork, neglected
coughs and colds, and other diseases such as syphilis
will greatly increase the chances that the disease may
gain a foothold and cause consumption to develop.
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There are various forms and varieties of tubercle
bacilli. The two great groups into which they are
divided are the human and the bovine types. It
has been found that the germ which causes tuber-
culosis in cattle varies in many ways from the germ
causing human tuberculosis. It is likewise true,
however, that the bovine type of organism may and
often does cause tuberculosis in human beings.
The great source of such infection, naturally
enough, is the milk of cows having tuberculosis.
It is possible that a large percentage of cases of
what is called " surgical " or non-pulmonary tuber-
culosis, such as bone, joint or glandular disease,
comes from this source. Butter and cheese, both
milk products, and beef are likewise possible sources
For these reasons a clean milk supply is essential.
There are many who think that there is much exag-
geration and needless alarm in the modern campaign
for clean dairies and healthy cows free from tuber-
culosis and other diseases. This, however, is the only
way in which we can eliminate the danger of infec-
tion from this source. Prevention is far better than
cure and costs less. Pasteurizing all milk whenever
there is any reason for doubt is a simple procedure
and a sure way to remove all its dangers. The milk
to be pasteurized is simply heated to 165 F., kept
at this temperature for twenty minutes, and is then
allowed to cool on ice. The nourishing qualities
and digestibility of the milk are in no way impaired
by this process.
Under ideal conditions it ought not to be
necessary to pasteurize milk. Milk from a tuber-
culin-tested herd is perfectly safe. Such herds are
at present hard to find, however, and it w T ill be many
years before the public realizes the necessity of de-
manding that this be done to all herds.
In the meantime, if in any doubt, pasteurize your
EARLY AND IMPORTANT SYMPTOMS OF
Consumption is a local disease with both local
and general manifestations. In other words, al-
though the tuberculous process is localized in the
lungs, its symptoms may refer not only to the
lungs but to every part and organ of the body.
Hence the terms " local " and " constitutional "
symptoms. Failure to recognize this fact on the
part of physicians has led to many errors in diagno-
Cough is an early and constant symptom ; w 7 ith the
cough there may or may not be sputum. There is
no cough characteristic of consumption. The so-
called " hacking " cough is no more characteristic
of consumption than any other kind of cough.
Any cough which lasts over three or four weeks re-
gardless of anything else should be carefully in-
Blood spitting is a most important sign. It is
far safer to take it for granted that the raising of
blood, blood spitting, either clear or mixed with
sputum, in large or small amounts, with or without
cough or other symptoms, means tuberculosis of the
lungs until the contrary is definitely proved. Fail-
ure to do this has resulted in countless tragedies.
If your physician says that the blood comes from
the nose, teeth, gums, tonsils, throat or stomach, go
to another doctor and get this statement confirmed.
It is possible for blood to come from any of these
sources, but very improbable.
Pleurisy causing pain in the chest is usually a
form of tuberculosis. If the pleurisy is a " wet "
one, i.e., accompanied by water inside the chest, it is
practically always due to tuberculosis and should be
treated as such.
Hoarseness lasting over a few w 7 eeks is an impor-
tant symptom, requiring rigid investigation. It
may be an early sign but is usually a late manifesta-
tion of the disease.
These symptoms about to be described are of the
utmost importance; likewise they are most fre-
Fever, unless the real cause is clear and definite,
should be looked upon as very suggestive of tuber-
culosis. When a person becomes hot and flushed
in the late afternoon, and on taking the temperature
is found to have some fever, even though slight,
look out for tuberculosis. Call the doctor and have
him investigate it. The normal temperature is any-
where from 97 to 98.9 Fahrenheit. A tempera-
ture of 99 or over requires investigation.
PULMONARY TUBERCULOSIS 19
Loss of weight. The average person either gains
weight or holds his own weight with slight varia-
tions, depending on the season and other self-evi-
dent causes. Any loss of weight, sudden or grad-
ual, which cannot be explained is a serious condition.
If this loss of weight is accompanied by a loss of
strength and energy, the condition is a doubly seri-
ous one. Constant fatigue, " that tired feeling/'
especially in the morning, listlessness, ease of tire,
should have some adequate explanation. If none
can be found tuberculosis must be at least consid-
ered as a possible cause. Night sweats, chills,
flushes, pallor, loss of appetite, all sorts of dyspep-
sias and irritability are minor symptoms to which
the physician's attention should be called. " Influ-
enza/' " malaria," " low fever," " walking typhoid,"
are frequent diagnoses given to explain symptoms
really caused by tuberculosis.
The important signs and symptoms of early tu-
berculosis, or consumption, therefore, with which
the layman should be familiar are as follows :
1. A cough with or without sputum lasting over
2. Blood spitting.
3. Unexplained fever, especially if associated
with a rapid pulse.
4. Unexplained loss of weight and strength.
These may not mean tuberculosis, but in the great
majority of instances they do, and therefore require
thorough investigation. Do not neglect them, But
go to a doctor and tell him about them.
WHAT TO DO IF YOU THINK YOU MAY HAVE
In the last chapter the important signs and symp-
toms of early consumption were discussed. If you
have any of these symptoms, or if for any reason
you think you may have the disease, do not delay,
but go to your doctor at once and tell him about it.
Remember that this may be the most important step
in your life; that tuberculosis is easy to cure if taken
in hand early enough, but that in the later stages it
is most difficult and often impossible to cure. There-
fore, if you have a cough with or without sputum,
especially if it is associated with loss of weight,
strength, etc., or if you feel tired and listless zvith-
out good reason, and always if you have ever spat
up any blood, go to the best doctor you can find
and tell him frankly all about it. If the doctor says
you are simply run down, or have a mild bronchitis,
or that the blood came from your nose or throat, re-
member that all doctors are liable to make mistakes,
and that you may possibly have tuberculosis after
all. If, after faithfully following out the treatment
he has outlined, you still feel just as badly as be-
fore, go to another doctor, or a tuberculosis dis-
WHAT TO DO 21
pensary or to a specialist on the subject. Remem-
ber that it is your life and your health which is at
stake and that you have a right to secure as many
opinions as you please.
If you live in a large city or town, there is almost
sure to be an anti-tuberculosis association which
maintains or can refer you to a good dispensary
where specially trained men can examine you. If
there is no such organization, write for advice as to
where to go and what to do to your State Board of
Health, or your State tuberculosis association. In
Massachusetts, for instance, a letter addressed to
the State Board of Health, the Massachusetts Tu-
berculosis Commission, or the Massachusetts Anti-
Tuberculosis League, Boston, or a letter to the
National Tuberculosis Association, New York City,
will reach the proper designation and will bring a
prompt and reliable answer to all your questions.
Remember that your health is your stock in trade
and your bank account. No sacrifice is too great to
guard it. Even if it costs a great deal in time,
trouble and money, it is all well spent and invested
at high interest if you find out the exact condition
of your health, and whether or not you have con-
sumption. You are like one fighting in the dark un-
til you know the exact state of affairs. Knowledge
is power and will enable you to act intelligently and
to keep your health, ward off disease, or to cure it.
WHAT TO DO IF YOU ARE TOLD AND KNOW THAT
YOU HAVE CONSUMPTION
Let us now take up the case of a man or woman
who has had some of the symptoms above described,
who has been to a good doctor or dispensary, and
has been told that he or she has consumption in its
early stages. What are you going to do about it?
.What is the next step ? These are constantly recur-
ring questions, and on the correct answers to them
hang life and happiness.
In the first place, do not give up. Make up your
mind to fight. Remember that countless thousands
have had the same problem to meet that you now
have, and have faced it bravely and have won out.
What they have done, you can do. Remember, also,
that you are dealing with a chronic, one of the most
chronic, diseases. It has taken many months or
even years for the disease to develop in your body,
and it will take as long a time to conquer it. Pre-
pare to spend at least the next year of your life in
getting well. Do not think you can carry on any
other occupation or business at the same time.
The best occupation for a consumptive is that of
WHAT NEXT TO DO 23
getting well." This wise motto stands over the
entrance to one of the oldest and most famous san-
atoria in the world.
Do not look too far ahead or attempt to do
everything at once. The patient often under-
goes a sort of panic or mental collapse after he is
told by the doctor, no matter how kindly, that
he has consumption. This may occur in your case.
It will soon pass off and you will find yourself able
to face bravely and even cheerfully the problems
of the present and the future. If your doctor gives
you no clear or definite instruction, but merely deals
in vague generalities, such as to " live outdoors,"
or to " go out West," go to another doctor who can
and will outline for you a practical and clear plan of
campaign. This is of vital importance.
Make up your mind to do something, and to do it
at once. Put away all pride unless your finances
are such that you can afford this luxury. Few of
us are able to do so. It takes a long time, and
costs money, to cure consumption, and your plans
must include not only the present but the future.
Do not worry any more than you can help. This
never did any good. If you are "up against it"
financially, there are many state, county or munici-
pal sanatoria where the cost is little or nothing. Be
As a general thing, there are three courses open
to you, which will be considered in detail in subse-
i. Home treatment.
2. Treatment in a local or not far distant sana-
3. Treatment at a distance and in another cli-
mate, such as Colorado and the West or South.
What the home treatment of consumption should
be and what it usually is are unfortunately two
very different things. Of late years we have made
tremendous advances in this method. Ten years
ago, home treatment merely meant that the patient
lived at home ; he rarely slept outdoors ; he followed
no definite rules or regulations as to exercise, rest,
etc., and was under no close or adequate super-
vision. To-day, thanks to the work of Dr. Charles
L. Minor of Asheville, North Carolina, and of Dr.
Joseph H. Pratt of Boston, the " home sanatorium
treatment," as it is called, may be one of the most
effective means that we have at our disposal of treat-
The difficulties of home treatment increase as the
finances decrease. Remember that it is not so in-
expensive as it seems; although you are not pay-
ing out a certain definite sum each week for board,
some one is paying the bills just the same. The
advantages of home treatment are as follows : —
i. There is no need of breaking up home and
2. The patient may be happier and more con-
3. If he gets well, he does so in his own and not
a different climate. His chances therefore of keep-
ing well in this climate are better.
4. There is no radical and dangerous sudden
change which the sanatorium patient undergoes
on leaving the institution to return home.
The disadvantages of home treatment may be
summed up as follows : —
1. There are no strict rules and regulations.
There is a constant temptation to do too much and
to do the wrong things.
2. There is not the strict and constant medical
supervision which exists in the well-run sanatorium.
3. The great help provided by the example of
what others are doing who have the same disease
and who are getting well, is lacking.
4. The climate, air and surroundings are rarely
so good as at a sanatorium or health resort.
5. It is often more difficult to sleep outdoors
and to lead the strict sanatorium existence at home,
especially in a large city, on account of publicity,
This, in my opinion, is a fair statement of the rel-
ative advantages and disadvantages of home treat-
ment. Home treatment as carried on by the men
to whom I referred above, Dr. Minor and Dr.
Pratt, has many of the advantages and few of the
disadvantages. Such men, however, are rare.
Home treatment as it is usually carried on by busy
general practitioners falls very far short of this.
The patient with ample means, who can afford a
HOME TREATMENT 27
good sleeping porch, nurses, and constant high-class
medical attendance may do very well at home. In
most instances, I think it dangerous for those in
poor or even moderate circumstances to attempt it.
The essentials of home treatment are as fol-
1. Outdoor living and sleeping. This will be
considered in detail in the next chapter.
2. Persistent, absolute and prolonged rest until
all symptoms, fever, high pulse, cough, sputum, loss
of appetite, etc., subside and then graduated exercise
under strict medical supervision.
3. Diet up to the limit of digestion, according to
no hard and fast rule, but to suit individual needs.
Diet in consumption will be taken up in a later chap-
4. Faithful and persistent attention to details.
5. A competent physician who is willing to spend
the time to attend to every detail, and who knows
how to do so.
It will be readily seen that it is not easy to meet
all these qualifications of proper home treatment.
In many instances, however, it seems the wise course
to pursue. As a general rule, when home treatment
is decided upon, a preliminary stay at a sanatorium
or health resort if only for a short time will be of
immense value in instructing the patient to carry on
proper treatment at home.
HOW TO LIVE AND SLEEP IN THE OPEN AIR
By Thomas Spees Carrington, M.D.
Published with the permission of The National As-
sociation for the Study and Prevention of Tuber-
Consumption, or tuberculosis, is a disease of the
lungs which is taken from others and is not simply-
due to catching cold. It is generally caused by-
germs, known as tubercle bacilli, which enter the
body with the air breathed. The matter which con-
sumptives cough or spit up usually contains these
germs in great numbers, and if those who have the
disease spit upon the floor, walls or elsewhere, the
matter will dry, become powdered, and any draught
or wind will distribute the germs in it with the dust
in the air. Any person may catch the disease by
taking in with the air he breathes the germs spread
about in this manner. He may also contract the
disease by taking into his system the germs con-
tained in the small drops of saliva expelled by a
consumptive when coughing or sneezing. It should
HOW TO LIVE IN OPEN AIR 29
be known that it is not dangerous to live with a con-
sumptive if the matter coughed up by him is prop-
erly disposed of.
Consumption may be cured at home in many in-
stances if it is recognized early and proper means
are taken for its treatment. When a member of a
family is found to have consumption and cannot be
sent to a sanatorium, arrangements for taking the
cure at home should be made as soon as the disease
The following directions are published to help
persons to carry out the open-air treatment in their
own homes. Many families are unable to make
any great change in their mode of living and can-
not afford to fit up porches and buy extra bedding
or warmer clothing. A number of the suggestions
given here are very simple and inexpensive, and will
help those who would like to use what they have
at hand in making an outfit for outdoor life.
It is important, in the treatment of tuberculosis,
to breathe air that is fresh and pare, to eat an abun-
dance of good food, to stop heavy work and worry,
and to take a bodily and mental rest by lying down
before and after the noon and evening meals. To
obtain the first, the patient must live out of doors.
This means that as many hours of the day and
night as possible should be spent in the open air,
and in order to carry out this treatment some place
must be provided which is not only protected from
wind, but also from rain and snow, as nothing ex-
cept the most severe cold weather should prevent
the patient from living and sleeping there. The
outdoor shelter should be large enough for a bed, a
reclining-chair and a table. It should overlook
pleasant and sanitary surroundings if possible, as
it is to be the home of the patient for months, and
will give better results if comfortable and attractive.
HOW TO TAKE THE OPEN-AIR TREATMENT IN A
Tenement house dwellers and persons living in
apartment houses in large cities should make every
effort possible to give the open-air treatment to a
member of the family who contracts tuberculosis.
First, consider the possibility of moving into the
suburbs or nearby small towns. If this cannot be
done, try to obtain from the landlord the use of the
roof, and build a small shack there as described
later on in this chapter. If this is beyond the
means of the family, use one room with a window
opening on a street or large court for the patient,
and then place the head of the bed beside the window
and cover it with a window tent. The cost of
a window tent is about $10.00, and if it cannot be
obtained, take two large, heavy cotton sheets, sew
them together along the edge, tack one end of the
double sheet to the top of the window casing and
drop the lower end over the outer side of the bed,
fastening the bottom of the sheet to the bedrail with
tape. There will be enough cloth hanging on each
side of the window to form the sides of the tent,
and these should be fastened to the window casings.
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HOW TO LIVE IN OPEN AIR 31
A window tent can be made at home for about $3.00
by using 12 or 15 yards of heavy denim or light
canvas. One straight piece of denim should be hung
from the top of the window casing to the outer side
of the bed, and the openings between this and the
side window casings filled in with sides cut and
fitted from the balance of the cloth. By these meth-
ods the patient gets fresh air from the window and
the room is kept warm in cold weather as a place
for dressing and toilet purposes. During mild and
warm weather, the tent can be removed and the
window kept open both at top and bottom.
The flat roofs of tenement and apartment houses
in large cities should, if possible, be used as a breath-
ing place by the tenants. Shacks or cabins can be
built upon them at small cost and make an econom-
ical and easily provided shelter.
HOW TO BUILD A SMALL SHACK OR CABIN ON A FLAT
ROOF IN THE CITY
Two by four timbers should be used for the frame
and siding boards for the back and sides. The
front of the shack should face slightly to the east
of south and be left open, but arranged with a can-
vas curtain, tacked on a roller so that it can be
closed in stormy weather. The shack can be built
cheaply with rough boards and the roof cov-
ered with tar paper or other roofing. As the vast
extent of flat roof space in all cities and in many
towns should be used for outdoor living and sleep-
ing, detailed plans for building a shelter on them
and a list of material, together with the approxi-
mate cost, are given. The list will be understood
by any carpenter, and when the shelter must be built
economically it is advisable to confer with the
neighborhood carpenter, rather than place the con-
struction in the hands of a contractor or builder.
LIST OF MATERIAL AND ESTIMATE OF COST FOR CON-
STRUCTING A SMALL OPEN-AIR SLEEPING SHACK
ON A CITY ROOF OR IN A COUNTRY YARD
328 feet of rough lumber as follows, at $30.00
per M, $9.84.
4 pieces, 2 inches by 4 inches by 12 feet, sills.
5 pieces, 2 inches by 4 inches by 12 feet, floor
14 pieces, 2 inches by 3 inches by 14 feet, studs.
5 pieces, 2 inches by 3 inches by 12 feet, plate.
1 piece, 2 inches by 6 inches by 12 feet, plate
1 piece, 2 inches by 8 inches by 12 feet, rail for
9 pieces, 2 inches by 4 inches by 14 feet, rafters
and rafter tails for front eaves.
300 feet of novelty siding for walls at $30.00
per M $ 9 . 00
250 feet of shiplap roof boards at $26.00
per M 6.50
200 feet of 7-8 inch common flooring at
$32.00 per M 6.40
One-half roll Neponset Red Rope Roofing at
$5.00 per roll 2.50
u U u U 1
Front view, Floor plan and Elevations of a shack for flat roofs, to go with
list of lumber below. Loaned by Mr. \V. H. Scopes
HOW TO LIVE IN OPEN AIR 33
10 pieces of i-inch half round for roofing at
1 cent per foot 1 . 40
1 canvas curtain on roll 5 . 00
4 sliding sash, 3 feet by 3 feet, at $2.00 8.00
1 casement sash and frame, 2 feet by 2 feet,
at $2.00 2 . oo
Hardware 1 . 00
Strips for sliding sash 1 . 00
Paint ...... 5.00
Labor 2 5»oo
Note. — Canvas can be bought by the yard and a
curtain made at home.
HOW TO ARRANGE A PORCH ON A HOUSE IN
If the family lives in a small town or in the coun-
try, it will usually be found that a porch is the most
convenient way of providing open-air quarters. In
selecting a site for the porch, it is well to remember
that the patient should be placed out of doors in
such a way that the cure can be taken with comfort
at all seasons of the year. For the winter months
the best place is on the south side of the house, as
there will be found the greatest amount of sunshine.
If this cannot be done, choose first the east, or sec-
ond the west side, but not the north side except as
a last resort, for it is a w T indy and cold position in
winter. The back of the house is usually better
than the front as the porch cannot be seen from
the street, but what is of the most importance is to
find a sheltered spot protected from the wind, for
the wind is much harder to bear than even intense
cold. When a house has permanent verandas and
the family cannot afford the expense of providing a
special porch for the patient, the permanent veranda
on any floor may be used and privacy and protec-
tion obtained by putting up canvas curtains or bam-
If a special porch for winter use is to be built,
place it on the south side of the second story of the
house, with an entrance into a room which can be
used by the patient. For a passageway to the porch
cut one of the windows down to the floor and put
in a door 3 feet 8 inches wide, so that the bed can be
rolled from the room to the porch without difficulty.
If the room is not heated by some other means, a
stove should be used and the air kept warm, so that
the patient may have a comfortable place for dress-
ing, eating, and to enter when chilled. Build the
porch out from the door 10 feet wide by 10 feet
long and 7 feet or more in height from floor to
ceiling. Place glass and sash on the side of the
porch most exposed to the weather, and hang can-
vas curtains on rollers to enclose the open sides in
stormy weather. Lay the floor with narrow
spruce boards, using white lead and oil to fill in the
cracks, at a grade of 1 inch to 5 feet, so that water
will not stand during stormy weather. A porch of
HOW TO LIVE IN OPEN AIR 35
this kind can be built in small towns and in the
country for from $50.00 to $100.00, the cost de-
pending upon the class of material used and the way
the porch is finished.
HOW TO BUILD A CHEAP PORCH
A useful porch can be built for $12.00 or $15.00
with cheap or second-hand lumber, and if only large
enough to receive the bed and a chair will still be
effective for the outdoor treatment. The roof can
be made with a canvas curtain or a few boards and
some tar paper. The end most exposed to the wind
and rain and the sides below the railing should be
tightly boarded to prevent draughts. A window
can be used for the approach, but it will be more
convenient if it is cut down to the floor and a small
Dutch door put in below the window-sash. Second-.
and third-story porches are supported from the
ground by long 4 by 4 posts, or, when small, they
can be held by braces set at an angle from the side
of the house.
HOW TO PROVIDE A SHELTER FOR THE SUMMER
AND FOR HOT COUNTRIES
Consumptives need a good shelter in tropical
countries and protection during the summer months
in northern climates. A porch should be placed on
the side of the house where the direct rays of the
sun will not strike it during the middle of the day,
and tents or shacks placed under shade-trees or in
the shadow of large buildings.
Awnings which jut out from the roof of a porch
or shack are used for shade, and Japanese drop cur-
tains made of long strips of bamboo for privacy,
as they do not stop the current of air.
In places where the streets are not watered, a
hose should be used to lay the dust in front of the
house, and the floor of the porch or shack sprinkled
once or twice each day to cool the surrounding air.
The open sides of the shelter must be screened
from the floor to the roof with wire netting as a
protection from flies and mosquitoes, and when this
is impossible, a mosquito-bar made of cheese-cloth,
netting or scrim should be hung from the roof or
laid over barrel-hoops attached to the head and foot
of the bedstead.
TENTS AND TENT HOUSES
Tents and tent houses can be used as a shelter in
warm, dry climates and for the summer months in
northern countries, but they are not very satisfac-
tory for winter use in cold climates.
In order to make a tent comfortable for a sick
person, it should have a large fly or double roof
with an air space between, a wide awning in front
where the patient can sit during the day, a board
floor laid a few inches above the ground and the
sides boarded up two or three feet from the floor.
THE BED AND BEDDING USED IN OUTDOOR
An ordinary iron bedstead with woven wire
spring 3 feet 6 inches wide and a moderately thick
HOW TO LIVE IN OPEN AIR 37
mattress are all that are necessary except for very
cold weather. A bedstead which can be rolled
about easily is a great convenience, and should
therefore be fitted with small rubber-tired w r heels or
casters. A good hair mattress is most desirable, but
when it cannot be obtained, a cotton- felt mattress
can be bought for as low as $4.00, or a wool mat-
tress for about $10.00. In northern climates, where
cold weather must be expected, two mattresses with
several layers of newspaper between them are often
used. Over the mattress place an old blanket or a
cotton bed-pad, the same width as the mattress, and
on this the ordinary bed-sheets or blanket-sheets.
BED COVERS USED IN OUTDOOR SLEEPING
Persons who like heavy bed covering may use
blankets, placing as many layers over the bed as de-
sired for warmth. Those who cannot stand heavy
covering can use down comforts, as they are very
warm but light. If these are too expensive, lamb's-
wool or cotton-filled comforts can be bought, or the
material for wool or cotton quilts can be obtained
for about $2.00 and warm, satisfactory covering
made in the home. Very cheap, light, but warm
covering can be made by using paper blankets placed
between two thicknesses of outing flannel or bed
covers. These paper blankets are sold for 50 cents
each and wear for about six months. A woolen
horse blanket with an outside of canvas can be used
as a covering to protect the bedding in wet and
In very severe weather a sleeping-bag may be
used for patients who are very susceptible to the
cold. These bags can be bought at department
stores for $15.00 upward, or can be made at home
by sewing blankets together around the edges, leav-
ing the top open. In making a bag, use as many
layers as may be desired, but place the same number
of thicknesses on both sides of the bag. The
blankets should be 7 feet long by 4 feet wide.
ARRANGEMENT OF PILLOWS IN OUTDOOR
Two pillows should be used in preparing the bed
before retiring. Place them in the form of an in-
verted V, with the apex at the top of the bed and
the head at the point where the two pillows meet.
This position allows the shoulders to nestle between
the pillows and protects them from the cold wind
which will otherwise find its way under the bed-
clothes when the patient lies on his side or turns
HOW TO PREPARE THE PATIENT FOR THE NIGHT
In cold weather the outdoor sleeper should get
into the bed in a warm room and have someone roll
him out of doors. When this cannot be done, use a
warm dressing-gown in going back and forth from
the dressing-room to the porch, and warm the bed
by placing in it for a few minutes before retiring,
HOW TO LIVE IN OPEN AIR 39
a hot-water bag, hot bricks, soap-stones or bottles
filled with hot water. In some instances it is well
to leave a- hot stone or bottle wrapped in flannel at
one corner of the bed, where it will throw off heat
slowly during the night.
In tucking in the patient at night, all covers ex-
cept the top blanket or comfort should be tucked
in under the bed-pad which lies on the mattress.
The topmost cover is then tucked under the mattress
to keep the under covers from sliding off when the
sleeper is restless. This method of tucking-in
forms a sort of sleeping-bag with the bed-clothes,
known as the Klondyke bed, and prevents the cold
air from reaching the body.
CLOTHING WORN AT NIGHT
The night clothes worn by the outdoor sleeper
during the winter depend largely upon the strength
of the patient. Some persons need much more
than others, but even the weakest can usually keep
warm if they have blanket-sheets and hot bottles.
A woolen undershirt, a sweater, and a long outing
flannel nightgown or bathrobe are usually worn,
but in very cold weather some patients wear a pair
of drawers made of flannel, a pair of bed-socks or
knitted slippers and a woolen abdominal bandage.
HOW TO PROTECT THE HEAD FROM DRAUGHTS
The head of the bed should be shielded from the
wind or a strong draught by placing it close to the
protected end of the porch, or by covering it with a
canvas hood supported on a barrel-hoop attached to
the bedstead or hung by a rope from the ceiling.
The patient can wear a knitted skull-cap long
enough to be pulled down to the end of the nose
and over the ears, or a knitted helmet which covers
the whole of the head, face, and neck, with the ex-
ception of a small opening for the nose and mouth.
A hood shaped like an old-fashioned sunbonnet is
very comfortable, and can be made at home from
eiderdown or outing flannel by using as many thick-
nesses as may be needed. Never cover the head
zvith the bed-clothes. If the nose grows cold, use a
small piece of flannel, held by elastic bands from the
ears, to cover the top, or a piece of cotton held in
place by a strip of adhesive plaster. Care should
be taken not to interfere with the inhaling of fresh
air or to allow the breath as it is expelled from the
nose or mouth to come in contact with the cloth and
form icicles. Chapping of the face during the night
can be prevented by using cold cream or vaseline
about the nose and lips.
CLOTHING FOR DAY USE
The clothing for use during the day when the pa-
tient is up or sitting in a reclining-chair should be
of light weight but warm. Underclothes of half
cotton and wool or linen mesh, and a sweater which
buttons in front, with the ordinary outer clothes,
are usually worn. The overcoat for men, women,
and children should be of fur if possible, as even the
cheapest of skins are warmer than any other kind
HOW TO LIVE IN OPEN AIR 41
of garment. If a new coat cannot be bought, a
heavy cloth overcoat will give good protection, and
be much warmer if it has a high, soft collar.
Leather leggins and woolen tights are used as extra
garments, and are a great comfort when taking ex-
ercise on cold days.
HOW TO PROTECT THE HANDS
Patients who wish to use their hands while sitting
out of doors in cold weather can wear thin, well-
fitting cotton gloves. These are used by army men,
and can be bought for thirty cents a pair. Over
them should be drawn a knitted woolen glove with
the ends of the fingers and thumb cut off and bound
to prevent unraveling. For ordinary protection,
when not at work, a heavy fur or woolen mitten
should be worn with long, woolen wristlets. Never
use tight gloves of any kind in cold weather, as
they restrict the circulation of the blood and cause
the hands to grow cold.
HOW TO PROTECT THE FEET
Use woolen stockings, and if they cause irritation,
wear a cotton stocking next to the skin. Sometimes
two or more pairs of woolen stockings are necessary
in very cold weather, but they must always be large
enough to fit loosely. Felt shoes are warm and
light, and are much used. Soft leather shoes cov-
ered by large fur-lined leather shoes are very warm
and comfortable, but are expensive, as they must
be made in a set, to order. Foot-muffs should be
used in sitting out during a cold day. They are
made of fur or of cotton quilts sewed up like a bag,
into which the feet can be placed. On very cold
days the muff can be placed in a wooden soap-box
with hot bricks beside it, and newspapers wrapped
about the muff to fill in the empty space.
CHAIRS FOR DAY USE
An easy-chair is a great comfort to the patient
during the day. A steamer chair is easily obtained
and gives good service, and the canvas chair with a
wooden frame can be bought for $1.00, or the cane-
seat extension-chair for $2.50 up. A more durable
chair is made for this purpose with an iron frame,
costing about $25.00, which can be transported and
used in a rough manner without danger of break-
age. To prevent the cold currents of air reaching
the patient from below, the chair must be covered
with some thick, closely woven, warm material. A
fur rug is the best for this purpose, but several lay-
ers of blankets and newspaper will answer and are
TABLE FOR WORK AND AMUSEMENT PURPOSES
The patient should have a table handy on which
to keep books and other things used for amusement
or work. An adjustable table, the top of which the
patient can swing before him or away, is a great
convenience, and can be used as a book-rest when
the hands are under cover.
HOW TO LIVE IN OPEN AIR 43
GENERAL DIRECTIONS FOR THE CARE OF THE
The directions for the care of the patient are not
intended in any way to take the place of a physi-
cian's orders. Every consumptive should consult a
doctor, and these suggestions are given to help the.
patient carry out his directions. Rest is a most
important part of the open-air treatment, and exer-
cise must be regulated by the doctor. Always have
at hand an extra wrap, and never remain out if
chilled. Cold weather should have a bracing effect,
and when it does not, go into a warm room and get
a hot drink, preferably milk, remaining indoors until
comfortably warm. When going out again use
more wraps, and keep behind a shield or screen that
breaks the force of the wind. Always be cheerful
and hopeful; never waste your strength in anger or
by being cross. Lead a temperate life, go to bed
early and get up late ; do not use alcohol in any form
except when prescribed by your doctor. Do away
with tobacco if possible, and use only weak tea and
coffee in small quantities. Never swallow the mat-
ter coughed up, but always destroy every particle
by spitting in a paper or cloth which can be burned.
Never allow the hands, face or clothing to be soiled
by sputum, and if this happens by accident, wash
the place soiled with soap and hot water. Men who
have consumption should not wear a moustache or
beard unless it is trimmed close. Particular care
must be taken, when sneezing and coughing, to hold
in the hands before the face a cloth which can be
burned. Soiled bed-clothes, nightdresses, other
washable garments, and personal linen should be
handled as little as possible until they are boiled
prior to their being washed. The dishes used by the
patient must be boiled after each meal.
All the above means care and work, but must be
done both as a protection to the household and in
order to bring about a speedy cure for the patient.
TREATMENT IN A LOCAL OR NOT FAR DISTANT
SANATORIUM. HOW TO GET THERE
AND WHAT IT COSTS
As previously stated above, I believe that a stay
at a well-run sanatorium or its equivalent, even
though very short, merely a month or two, is a most
valuable help in carrying out subsequent treatment
at home or elsewhere. There are four reasons why
people go to sanatoria :
1. To learn how to live so as to be able to carry
on treatment faithfully and intelligently at home.
2. To get cured of their disease, if possible.
3. To stay cured, which is a very different propo-
sition from merely reaching the stage when the
process is called " arrested."
4. To learn how to help others and to keep them
from getting sick.
There are sanatoria, public or private, in every
State in the country. The cost of board varies from
fifty to one hundred dollars a week down to nothing.
For the vast majority of patients, only those insti-
tutions where the cost of board is very moderate or
low are at all available. In some states there are
no state or local low-priced sanatoria, and the pa-
tient, if in m'oderate or poor circumstances must
make other arrangements. The difficulty usually
consists in the fact that the average busy general
practitioner has only the vaguest ideas on the sub-
ject, and can give no very definite instructions to his
patient as to what to do or how to do it. At some
state sanatoria only incipient cases and at others
only those in the advanced stages are admitted,
while a few take patients in all stages. Some de-
mand payment of board from every patient, there
being no provision for free treatment ; at others the
cost is four or five dollars only if the patient is able
to pay it, while at still others, treatment is free for
all. To some state institutions patients are admit-
ted after making application on a blank, which any
physician may fill out ; others have special examin-
ing physicians who must see the applicant and decide
as to his or her fitness to enter. Some sanatoria are
at considerable altitude, others at nearly sea level.
The cost of fares and the distance from home should
be definitely known. All these points are important
ones and of great practical value to the patient and
his family and friends. The problem is how to find
This is not difficult if the way is known. Those
who care to consult a specialist and get definite in-
formation, and can afford to do so, should not hesi-
tate to ask their family physicians to be referred to
such a person. The very poor have this advantage,
in that they can at any time go to a tuberculosis dis-
pensary or clinic (the name and location of such
TREATMENT IN A SANATORIUM 47
dispensary being found on inquiry from the State
Board of Health or Anti-tuberculosis Association,
as mentioned before) and there get the best of ex-
pert advice. Those who cannot do either of these
things, however, should write to the National Tu-
berculosis Association, 105 East 22nd Street, New
York City, for information or means of obtaining
information on every phase of this subject; in addi-
tion to this a letter addressed to the Journal of the
Out Door Life, at the same address as above, will be
printed, with a full answer, in the next issue of this
most admirable magazine. From the same sources
information in detail as to private sanatoria and
health resorts can be obtained.
Take, for example, the case of a patient, or friend
or relative of a patient, who wished to find out about
entering one of the state sanatoria in Massachusetts.
He would first write to the State Department of
Health at the State House in Boston. From there
his letter would be referred to the Massachusetts
Tuberculosis Commission, at 3 Joy Street, Boston.
The Secretary of this Board would at once write to
the sender of the letter, answering the questions in
detail, and enclosing suitable printed matter, circu-
lars of information, etc. If necessary, a personal in-
terview could later be arranged. From the same
source application blanks and all details relating to
the institutions under this Board could be obtained.
Some such board or commission or source of infor-
mation exists in every state, whose services are at
the disposal of its citizens.
Private sanatoria cost more than state institutions
and offer certain evident advantages. The price of
board at the moderate priced ones ranges from $12
to $25 a week. There is, of course, more individual
attention given to each patient, but, on the other
hand, he has more freedom and is more likely to in-
terfere with his progress by attempting too much.
Whether at a large or a small institution, much de-
pends on the mental attitude of the patient toward
the disease, the doctors and the institution itself.
At the Massachusetts sanatoria, patients are divided
into two classes, the " Hospital " and " Sanato-
rium " classes. To the first belong those who look
upon the sanatorium merely as a first-class boarding
house, who will not co-operate with the doctors, who
refuse to follow the details of treatment, and who
break rules whenever they can do so without get-
ting found out. These patients almost invariably
do poorly. To the other class belongs the opposite
type of patient who really wishes to get well and
in so doing is willing to sacrifice some personal com-
fort and convenience in order to adhere rigidly to
every slightest detail prescribed by the physicians.
These patients do not always get well, but they do
far better than the others. A card bearing the fol-
lowing suggestions is given to every patient before
admission to a Massachusetts sanatorium. It would
be well for everyone affected with this disease to
study and digest the advice here given.
TREATMENT IN A SANATORIUM 49
ADVICE TO PATIENTS ABOUT TO ENTER A
You are about to enter a sanatorium in order to
regain your health. Please read over the following
suggestions carefully :
1. Remember that your disease — tuberculosis
— is a chronic one, and that it is cured only by pa-
tience, perseverance, and faithful attention to details
over a long period of time.
2. Remember that you are going to the sanato-
rium not only to cure your disease or to arrest its
progress but also to learn how to live so as to
KEEP WELL AFTER YOU LEAVE THE SANATORIUM.
3. Bear in mind always that unless you do
learn how to live while at the sanatorium and follow
out these rules of living after you leave you will be
very apt to have a relapse of your disease later on.
4. Remember that w T hile at the sanatorium you
must obey certain rules and regulations. These are
absolutely necessary. Nothing unreasonable will be
asked of you. The more closely you adhere to
these rules and do what the doctor says, the better
are your chances of getting well.
SARANAC LAKE. WHERE IT IS, WHAT IT OFFERS
TO THE CONSUMPTIVE, AND HOW TO GET
I am taking Saranac Lake and the sanatorium
there situated as the best example I know of a health
resort where patients of moderate means as well as
those who are better off can find high-class ac-
commodations and receive the best of treatment.
There are other places equally good, such as Liberty,
New York, or Asheville, South Carolina. I shall
describe in detail the village of Saranac Lake itself
and what it offers to consumptives because I believe
that in many ways it has more advantages and
fewer disadvantages than any other place I know.
I send my own patients there, and, when visiting
Saranac Lake myself, I find a constant source of in-
spiration and renewed vigor in this little mountain
Over twenty-five years ago, a New York physi-
cian, Dr. Edward L. Trudeau, was told by his med-
ical advisers that he had consumption and must at
once leave the city. This he did, giving up every-
thing that meant to him success in his profession.
He went to the village of Saranac Lake and there
SARANAC LAKE 51
spent the winter nearly alone, living an outdoor life.
To the surprise of his friends he rapidly improved.
He finally started a little sanatorium for a few pa-
tients, so that other sufferers might profit by the air
and the climate and lead the life which had proved
such a boon to him. This was the beginning of the
Adirondack Cottage Sanatorium, — now a large,
flourishing and famous institution. Despite his
tremendous handicap, Dr. Trudeau has done a great
work and has brought hope, health and happiness
to countless victims of tuberculosis.
The village of Saranac Lake is in the Adirondack
Mountains, north of Albany, an all night's ride from
New York or Boston. The elevation of the town
itself is about 1600 feet, but it is surrounded by
some of the highest Adirondack peaks. There is a
permanent population of over 6,000. The climate
is a typical one of that region — cold and dry in
winter and fairly warm, though rarely uncomfort-
ably so, in summer. The winter, spring and fall
are the popular months, March is apt to be wet
and stormy. There is not as much sunshine as
there is in the South or the West, but as much as
or more than in New England and the Northeast.
The air is dry and intensely stimulating. One can
sit out of doors with the temperature far below zero
without discomfort. In the summer, as in all such
places, there are apt to be a few inLensely hot days,
but for the greater part of the time one can be per-
The cost of board at the sanatorium itself is $8
a week. Only early and favorable cases are taken
at this institution, for whom there are special exam-
iners in New York, Philadelphia, Boston and other
large cities of the East. The names and addresses
of these physicians can be obtained by writing to the
sanatorium itself, or to any local anti-tuberculosis
association. The great majority of patients are not
in the sanatorium, but live outside, in or near the
village, in private boarding houses, or keeping house
for themselves. One cannot get good board at
Saranac Lake for less than $14 a week; the patient
can pay as much more than this as he cares to spend.
The cost of medical attendance is very low.
Saranac Lake, which is entirely distinct from the
village of Saranac, can be reached from New York
or Boston by a through night sleeper which leaves
late in the afternoon and arrives at the village at
about six the next morning. From Montreal and
the North and from the West there are also through
trains. No one should go to this place unless
definite arrangements have been made beforehand.
The patient's local physician should write to one of
the Saranac Lake doctors and state in detail the
medical side of the case; the patient himself or his
family should also write, giving details as to
finances, price to be paid for board (always remem-
bering that this is a question of mbnths and not
merely a few weeks), the exact date of arrival, etc.
Until all such arrangements are definite and clear,
the patient should not start on his journey. On ar-
SARANAC LAKE 53
rival in the morning, he should take a carriage (the
fares are very low) to a hotel, where he can get
breakfast and rest for a while. Unless it has been
arranged beforehand, he should then get in touch
with the doctor who is to have charge of the case
and plan to meet him or be directed to the boarding-
house or home where he is to stay permanently.
All questions concerning every detail of life at Sara-
nac Lake will be promptly and accurately answered
by writing to the Secretary of the Saranac Lake So-
ciety for the Control of Tuberculosis.
One is very likely to think of Saranac Lake as a
place where wan- faced invalids abound. Nothing
is further from the truth. It is true that many sick
people go there, but on the whole, the atmosphere
of the place is cheerful, bright and optimistic. I
well remember a friend, himself a patient, who had
been at Saranac for years, saying to me : u Doctor,
we're all chipped and broken pottery here, but we
rattle around and make a very cheerful noise after
all ! ,: Patients spend their daily stint of eight hours
out of doors without complaining or grumbling.
The first week or so may be hard, but after this
the force of the example of what everyone else is
doing is so strong, and the results are so good that
one accepts the situation without a murmur. The
honor system prevails. It is easy to break rules
and regulations, and to disobey the doctor if you
want to; but you don't want to. This is why so
many people are cured up there who never would
have been cured at home, simply because they could
never have stood the strain of carrying on by them-
selves the rigid sanatorium regime.
I do not wish to give the impression that Saranac
Lake stands alone and that there are not many other
places where as good results can be obtained. I take
Saranac merely as an example. I do feel, however,
that it offers more for the money invested to those
who can go there than any other place I know.
COLORADO AND THE WEST
I have never sent a patient with active pulmonary
tuberculosis West or Southwest unless the patient
had enough money so that he did not have to worry
about the expense. Even so, the patients whom I
have told to go to Colorado or elsewhere in the West
form a very small and limited class. My reasons
for feeling this way are as follows : —
i. The great cost of transportation to the West
and high price of board at the sanatoria. Twenty-
five dollars a week is a very moderate price for
board, while at many institutions the price is fifty
2. The altitude is too high for patients with weak
hearts, and dangerous for those with a tendency to
3. The great distance from home and the impos-
sibility of visits from relatives and friends leads to
homesickness, loneliness, and mental discontent.
These are great handicaps in fighting tuberculosis.
These are the chief objections to life in the far
West for the average consumptive. There are,
however, certain advantages which must be given
due weight. The climate is remarkable in many
ways; there is sunshine and plenty of it winter and
summer, all the year round, and air so dry that it
is vastly easier to live an outdoor life with comfort
in the winter than it is in New England or even at
Saranac. This is a most important consideration.
While the altitude is dangerous or harmful to some
patients, there is absolutely no doubt that for those
able to stand it, it is of immense help. As far as
the comparative isolation is concerned, there is a
certain class of patients to whom separation from
friends and relatives is a great advantage and who
rather relish the independent Western life. All
these pros and cons must be carefully weighed and
balanced one against the other in considering each
case. The cost must always be borne in mind.
Many people have been cured in the West and many
have been hurried into a premature grave by going
there. Do not go West unless
(a) You are assured by competent medical advice
that your heart will stand the strain and that the cli-
mate is suited to your individual case.
(b) You have $1000 in cash to spend on proper
food and lodging.
(c) You know of some good doctor and have a
letter to him containing all details of your case.
Above all, remember that even if you go West
and do well there, you may never be able to come
back to the denser air and lower altitude of the East.
For further details as to sanatoria, etc., write to the
sources previously mentioned.
AFTER THE SANATORIUM, THEN WHAT?
A properly conducted sanatorium, public or pri-
vate, should prepare the patient for continued treat-
ment or work after leaving the institution. Sana-
torium treatment is as much for the future as for
the present. To gain ten or twenty pounds in
weight, to lose cough and sputum, etc., is evidence
that the progress of the disease is checked. But
unless the lessons learned at the sanatorium sink
deep into the patient's mind and unless he fully real-
izes that a few months at a sanatorium never really
cured consumption, the gain he has made will soon
be lost and the money he has already spent on him-
self will be wasted. Therefore, long before the pa-
tient leaves he should begin to think ahead and plan
for the future ; he should consider the feasibility of
outdoor sleeping at home and should be making in-
quiries for proper work or occupation. He should
consult his physician in regard to all these plans, es-
pecially as regards rest and exercise. Mere fat is
of no special value. A certain amount of increased
weight is advisable, but this should be as much
muscle as fat. Exercise in gradually increasing
amounts should be taken until at time of departure
the patient is in good physical condition. It is well
for the patient to bear in mind that a period of
" post-sanatorium depression " is apt to follow the
departure from the sanatorium. The sudden free-
dom from supervision, rules and regulations, the
doubt as to the future, which is often present in his
mind, and the suddenly acquired burden of new re-
sponsibilities may cause a sort of mental panic.
This lasts only a short time, and then passes away
The question is sure to come up as to what sort
of work is best to do, and whether or not the pa-
tient should go back to his old occupation. This de-
pends largely on the following :
(a) The condition of the patient and of his
lungs. If the disease is still active, hard work of
any kind is of course out of the question.
(b) Exactly what the occupation he wishes to
pursue involves as to hours, physical or mental
strain, etc. In other words, is it one of the so-called
" dangerous trades/' owing to dust, fumes, long
hours, exposure to heat and cold, etc. ?
(c) How the rest of the tw T enty-four hours dur-
ing which the patient is not working is to be spent.
I have often allow r ed a patient to return to his for-
mer occupation, even if it were not a favorable one,
on condition that he could sleep outdoors at night
and during the rest of the day live under good hy-
(d) The financial situation and the difficulty in
getting another job. When a patient is so situated
SANATORIUM, THEN WHAT? 59
that it involves no hardship for him to give up his
old trade and seek a new one, even if he has to wait
for it and then work at lower wages, it is certainly
better to advise this course of action. But this is
rarely the case. In the majority of instances, it is
essential for the patient to get back to work and
earn some money as soon as possible; likewise it is
usually quite impossible for him to start in all over
again and learn a new trade. It is a common thing
for doctors to tell their patients to " get a light out-
door job." It would be a good thing for these doc-
tors to try for themselves to secure an outdoor job
suitable for a consumptive or an ex-consumptive.
Then they would not give such useless advice. An
outdoor occupation is an excellent thing if it can be
found. Most patients must get w T ell without one,
Medical Supervision. There is no time when
there is more need of sound medical advice than
during the first six months or year after leaving
the sanatorium. Most patients are only too anxious
to leave behind them every trace of things medical.
This is a dangerous course to pursue. Every pa-
tient should go to his own local physician at once
after leaving the institution, and should report to
him regularly once a month during the first year
and once every two or three months for several
years. He will find the money thus spent in doc-
tors' fees an excellent investment. The patient who
does not do this runs a grave risk of having an
TUBERCULOSIS IN CHILDHOOD
Tuberculosis has been called a true children's dis-
ease. This is because in almost every case infection
with the germ of tuberculosis takes place in child-
hood. It is an amazing state of affairs, but un-
doubtedly true that by the time a child reaches his
fourteenth year he has already become infected with
tuberculosis. This does not necessarily mean dis-
ease, as before stated; there is, fortunately, a vast
difference between tuberculous infection and tuber-
culous disease. The first simply implies that some-
where in the body, causing no symptoms in the pres-
ent and very likely to cause none in the future, there
exists, tucked away in some gland or elsewhere, a
tiny focus of tuberculosis. That this occurs has
been proved by countless autopsies and other scien-
tific investigations. The fact that the majority of
us are well and strong and yet harbor these germs
somewhere in our body is sufficient evidence that
tuberculous infection does not necessarily mean sick-
Tuberculous disease should be applied to the con-
dition when these germs are no longer latent and in-
active, but are causing symptoms. These symptoms
TUBERCULOSIS IN CHILDHOOD 61
in childhood are usually different from those in
adults for the reason that actual disease of the lung
itself is rare and occurs only in the late stages when
the diagnosis is evident. In the early stages the
process is confined to the lymph nodes, especially
those at the root of the lung in which case the con-
dition is called " bronchial gland tuberculosis.''
The only local symptom which parents should know
is a peculiar paroxysmal cough like that of whoop-
ing cough. The important symptoms are the
" constitutional " ones. The more important con-
stitutional symptoms are:
(a) Loss of weight or strength or failure to
gain in weight and vigor.
(b) Debility, languor, listlessness, undue fa-
(c) Pallor or anaemia.
(d) Slight fever.
(e) Frequent colds without adequate cause.
(f) A poor or capricious appetite.
Remember that while other things may cause
each and all of these symptoms, that tuberculosis
may and often does cause them. Take the child
to your doctor and have him examined. If he fails
to gain or gets worse, consult a specialist or go to
a special dispensary where the child can be seen by
experts in this line. Do not attempt to diagnose
or treat the child yourself. Do not put off going to
your doctor, but do so at once.
HOW PARENTS CAN HELP IN THE PREVENTION AND
CURE OF TUBERCULOSIS IN CHILDREN
Remember that in the case of children as in
adults, good health should come first always. This
is especially true in children. In a few cases adults
can take risks and often have to do so, and continue
at their work although in poor health. With adults
the doctor often has to compromise and demand
only such measures as can be carried out along with
the patient's regular occupation. In the case of
children there should be no compromise. Except
in crowded city districts, the ailing child should be
at once removed from school and " put out to
grass," i. e., made to live out of doors in fresh air
and sunshine. In the large cities, where there is
little or no opportunity for fresh air and sunshine,
unless he can be sent out into the country, the child
should be sent to an open air school or some such
institution. Always remember that health comes
first, and that schooling is purely secondary.
Outdoor sleeping is hard to arrange for children
unless there is a separate house in the country or
suburbs, where a suitable sleeping porch can be ar-
ranged. The details of how to sleep outdoors have
HOW PARENTS CAN HELP 63
already been given in a previous chapter. Sun-
light is a healing power of great value. Exactly
in what way it acts we do not know, but we do
know that exposure of the child's body to the sun's
rays is of great benefit, even at low altitudes where
the air is not so rare and pure as in the mountains.
It is .only comparatively recently that " sunlight
treatment " or " heliotherapy " has been carried on
to any great extent. It is bound to become more
widely used as people realize its benefits. It should
be carried on only under a physician's direction.
The diet should be carefully supervised. In
feeding children, as with adults, bear in mind that
it is what can be digested and is digested and assim-
ilated and not that which is taken into the stomach
that is of value. Three meals a day, with a glass
of milk at each meal, and if the child is below
weight, light lunches in the middle of forenoon and
afternoon, is the basis of diet in such conditions.
No tea or coffee should be allowed. Be sure the
teeth are in good condition. Take the child to the
dispensary or the dentist and have this attended to.
Cold sponge baths every morning down to the
waist, followed by a brisk rub dow r n in a warm
room are of immense value. Do not have the wa-
ter any colder than the temperature at which the
child will react and get in a warm glow after bath-
ing. If there is no reaction and the child is cold
and blue, the water has been too cold. The rub-
bing afterwards with a rough Turkish towel is as
important as the bath itself.
Remove the child from all possible sources of in-
fection. If there is or has been a case of consump-
tion in the family or house, send the child away if
possible. If there is definite disease of the lung
itself, the child should be sent to a hospital or san-
atorium, and should not be kept at home. There
are not many institutions where such children can
be sent. Massachusetts and New York are fairly
well provided. Information about them can be ob-
tained from the sources mentioned above.
Many doctors advise exercises, calisthenics, etc.,
for this type of children. They are apt to be thin,
" scrawny," round-shouldered and stooping. Un-
der proper conditions a few simple " setting up "
exercises are of benefit. But it is easy to carry
this on too enthusiastically and to do harm instead
of good. These should never be allowed except
when ordered by a physician. It is well to remem-
ber that round shoulders and flat chests often result
from a general weakened condition. Under such
circumstances it is rest outdoors, good food, and al-
ways more rest which will build up the child, re-
store vitality and energy and allow him to sit up
straight of his own accord. Chest exercises, there-
fore, should be allowed only when the child is well
and strong enough to afford the spare energy neces-
sary for their performance. It is far better to em-
phasize rest in all such cases rather than exercise.
Above all things, remember that questions concern-
ing exercises and other matters should be decided
by the physician and not by parents or relatives.
FRESH AIR ROOMS AND OPEN AIR SCHOOLS. WHAT
THEY ARE AND WHAT THEY ARE FOR
The school children of to-day are the men and
women of to-morrow. The weak, sickly, anaemic
children of to-day are the consumptives of the next
generation. The movement for fresh air rooms
and open air schools is simply an expression of a
growing public sentiment that children need and
must have more fresh air and sunlight if we ex-
pect to have them grow up into healthy adults. Sci-
entists can prove to their own satisfaction, perhaps,
that the air forced into school rooms by some elab-
orate and expensive system of artificial ventilation
is pure and fresh and just as good as the air that
comes in through an open window; facts demon-
strate that this is not so and that no amount of
" baked " air equals that which comes into the room
unimpeded and in its natural state.
At the present time there are two great classes of
children who need treatment in fresh air rooms or
outdoor schools. The first and smaller class con-
sists of those children whom competent medical
authorities have declared to be not only tuberculous
but to have tuberculous disease in active form.
These children are sick children. They belong in a
sanatorium or hospital where health is the prime
consideration, and not in a school. For them
schooling is a very secondary matter. The New
York sanatorium at Stony Wold and the Massachu-
setts sanatorium at Westfield are institutions of
this type, sanatoria in every sense of the word, but
provided with outdoor schools for children able to
attend them. There are many smaller institutions
of the same kind in or near the large cities in this
country and abroad.
The other class consists of those children under
weight, often underfed, poorly nourished, pale
and run down, who, while they doubtless are al-
ready infected with tuberculosis, have no evidence
of active tuberculous disease, and who need good
food, proper hygiene, and fresh air to make them
well and strong. The distinction between these
two classes is often hard to make because one
merges into the other. It is important to realize
the difference, however. It is for these children
that fresh air rooms are intended. Such a room
may be simply one room in a schoolhouse set aside
for this purpose, where the windows are either
taken out or kept open, or it may be a shack, tent
or pavilion actually out of doors. The children are
adequately clothed to stand the cold weather.
Lunches, simple, nourishing and cheap are provided
at cost or free to those who cannot pay. A certain
period each day is set aside as a rest hour. Home
conditions are investigated. The interest of the
FRESH AIR ROOMS 67
parents is aroused so that both children and parents
learn the value of fresh air and the rules for right
The result in increased mental and bodily vigor
of these children is amazing. Such schools have not
been in existence long enough nor are there enough
of them as yet to show any appreciable effect on the
tuberculosis death rate or on the general health.
In a few years this effect will be clearly seen. By
that time the public will realize what those who have
studied the subject now do, — that all children
whether well and strong or weak and sickly, should
go to school and study in fresh air rooms and that
it is folly to wait until the child becomes run down,
sick and infected with tuberculosis before he is
given decent conditions at home and at school.
This is to be the next great step in advance.
CONSUMPTION AND MARRIAGE. WHAT SHOULD
CONSUMPTIVE PARENTS DO ABOUT THEIR CHIL-
The question as to whether or not a consumptive
should marry is one that frequently arises and is
very hard to answer. No definite ruling one way or
the other can be made. Each case must be decided
on its individual merits, depending on the age of the
patient, activity of the disease, finances, and other
conditions. As a general thing such marriages
should be discouraged unless matters have reached a
stage where breaking off an engagement would do
more harm than good. Certainly no young couple
should marry, if one has consumption, unless every
detail as to present and future plans are clearly and
plainly talked over between the two parties. If
the disease is active and there is no immediate pros-
pect of its arrest, marriage should be postponed in-
definitely. On the other hand, if the process is a
chronic one and one that the physician believes to
be compatible with a long and useful, although per-
haps a semi-invalid life, there is no reason why
there should not be a marriage, provided, as above
stated, that both the man and the woman in the case
CONSUMPTION AND MARRIAGE 69
are fully prepared to live according to what the dis-
ease demands and are financially able to do so.
Much depends on the intelligence of the contracting
parties. I know of many patients whom I should
not allow to marry under any circumstances if I
could help it, even though in the incipient and fa-
vorable stages; while on the other hand I know of
many more with chronic advanced or moderately
advanced tuberculosis, whom I would willingly al-
low to marry. After all, in these cases it is fortu-
nately or unfortunately true, according to the point
of view, that only rarely will serious weight be given
to any doctor's advice on this subject.
Again the question is bound to arise as to whether
there should be children from such marriages. If
it is the husband who is consumptive, I can see no
reason why there should not be children providing,
of course, all possible safeguards are taken to pre-
vent the child's becoming infected; if, however, it
is the wife who is afflicted, this matter should be
given the gravest consideration. Husband and
wife should both remember that pregnancy with its
attendant strain on all a woman's vital forces is the
cause of more breakdowns and relapses among
women than anything else; that many, many trage-
dies have resulted from this cause ; that tuberculous
disease that has been quiescent and free from all
symptoms for months or years previous may again
become active during pregnancy and the months fol-
lowing child-birth. If it is decided to take this
risk, the most watchful care on the part of the phy-
sician and the closest cooperation between wife
and physician is necessary to prevent disaster. Un-
der certain conditions it is right and proper to termi-
nate such pregnancy. This, however, is a medical
question only and need not be entered into here.
If one or both parents are or have been consump-
tive, what is to be expected of the children result-
ing from such a union? Remembering that tuber-
culosis itself is not inherited, but that a lessened
resistance or lowered vitality may be inherited, the
parents need have no worry as to the outcome if
they bear these facts in mind and act accordingly.
Knowledge of what may be transmitted from a tu-
berculous parent carries with it the power to ward
off future trouble. Such children should not be
nursed if the mother has active tuberculosis, but
should be weaned at once. They should be brought
up with the utmost care, not coddled or protected
from fresh air, but living in it night and day. They
should be protected from every source of contagion
and should be examined regularly and frequently
by a competent physician. If the child is reared
under such conditions as these, his parents need
have no fear, as far as tuberculosis is concerned,
that he will not be as strong and well as any other
child whose parents are apparently perfectly well
How to wrap a patient in a chair. The reclining-chair is first overlaid with
a rug or a comfortable, and double blankets extended their full length,
leaving the free ends on the floor. Loaned by the Journal
of the Outdoor Life.
How to wrap a patient in a chair. After seating yourself, draw up the free
ends of the blanket and tuck in at the sides. A steamer rug is placed
over all. Loaned by the Journal of the Outdoor Life
THE PROBLEM OF PAYING THE BILLS IN CONSUMP-
TION AND HOW THEY HAVE BEEN SOLVED
Tuberculosis is a chronic disease; it takes time
and money — plenty of both — to cure it
Whether the patient and his friends are able to
pay the bills, or whether they are paid by the state,
city or private charity, some one has to pay the
board and other expenses. Usually it is the tax-
payer who foots the bills ; some day the public, who
now pays the bills, will realize that it is far cheaper
to prevent consumption than it is to try to cure it.
The consumptive, unless he is very well off, should
put away all pride. Only the wealthy have a right
to pick and choose the exact sanatorium, climate
and situation that they want. Most of us cannot
do this, but must be content with what we can af-
ford. Many patients are unwilling to go to a state
sanatorium because they are not, as they say,
" charity patients." This is all nonsense. In our
state sanatoria patients are not officially pauperized
by entering on a free basis. True, if a patient says
he is unable to pay, his case is investigated by state
or local authorities to make sure of the facts. This,
however, does not pauperize him. Free treatment
at a state or local sanatorium is on the same plane
as our public schools and our police and fire pro-
tection. No one, even the poorest, would claim he
was pauperized by not paying for education in the
public schools. Tuberculosis is a great social and
economic problem and one that society and the
public must handle. For these reasons, then, when
a person has consumption and must go to a sana-
torium for an extended stay, he should face the
financial side in a practical and sane manner. If
he can afford $ioto$i8a w r eek at a private or semi-
private sanatorium for a long while, well and good ;
if he can pay only $4 to $5 a week, the usual cost
for those who can pay at a state sanatorium, let him
face the situation cheerfully. He should realize
that comparatively few can go to private sanatoria
and that he can get well just as quickly in the bigger
and less expensive institution. If he is so situated
that he cannot afford to pay for his board, let him
say so frankly to the proper authorities. In Mas-
sachusetts institutions, at least, the patient who can
pay his four dollars a week or more receives exactly
the same treatment in every detail as his less fortu-
nate fellows who can pay nothing. There is no
more important point to remember. In many
cases, the vast majority, immediate treatment is
highly desirable. Not only from the point of view
of the patient's physical welfare is this a good
thing, but also it is far easier for the patient to do
something at once, to take some radical step while
PROBLEM OF PAYING BILLS 73
the doctor's advice and warning is fresh in his mem-
ory, than to wait one or two months before so do-
ing. Unfortunately in Massachusetts and I believe
elsewhere, there is a long waiting list for all the
state sanatoria, so that the patient must wait one,
two, or even three months after he has filed his ap-
plication before he can be actually admitted to the
sanatorium. For many reasons, therefore, it is im-
portant to bridge over this gap. Under such cir-
cumstances I have advised many patients to go
at once to a private sanatorium, even at a cost
of $10 to $15 or more per week. While these
patients could not possibly pay at such a rate
as this for any length of time, many of them are
able to do so for a few weeks. It is really the eco-
nomical plan, because in most instances a few weeks
of immediate treatment, even at increased cost, will
be more than saved by the decreased length of stay
in the sanatorium later on. The following brief
reports of cases are those of actual patients, each
of whom presented a definite financial problem
which was satisfactorily solved.
A. A woman with two small children, whose
husband earns $2 a day, with no money saved, was
found to have moderately advanced consumption.
The children were sent to board with the grand-
mother, after having been examined themselves.
Application was made for admission to a state san-
atorium and in the meantime the patient was admit-
ted to a local hospital, the House of the Good Sa-
maritan. Five weeks later her name was reached
on the sanatorium list and she was admitted on a
free basis. She is now doing well.
B. A young clerk, single, with no one dependent
on him, earning $15 a week, had incipient phthisis.
He had $200 saved up. He was sent at once to a
private sanatorium in the village of Rutland at $14
a week, and application was made for the Rutland
State Sanatorium. When his name was reached
on the list he had done so well that he preferred to
remain where he was, even at increased cost. At
the end of two months he left the sanatorium,
moved his quarters outside the city to a suburb
where he now sleeps out of doors. At the end of
six months he was able to go back to work, his em-
ployers having kept his position open for him.
C. A young boy of ten years, whose mother was
a washerwoman, a widow, earning $10 a week, had
been ailing for some time. The diagnosis of
11 bronchial gland tuberculosis " was finally made
and sanatorium treatment advised. Application
was made for the Westfield State Sanatorium, Mas-
sachusetts, where children are taken. In the mean-
time, as there was no hospital or other institution to
which he could be temporarily admitted, his home
conditions were investigated in detail, his mother
instructed as to how to take care of him, extra milk
was supplied from a local diet kitchen, while the boy
himself came weekly to my clinic at the Massachu-
setts General Hospital. After two months' wait-
ing, during which time he improved rapidly, he was
PROBLEM OF PAYING BILLS 75
admitted to the state sanatorium, where he is now.
D. A young bank clerk, with a good position
bringing in $20 a week, but no savings, came down
with acute early tuberculosis. His wife was soon
to have a baby. The couple had lived up to their
income in an apartment in the suburbs. The prob-
lem was a difficult one, involving not only the hus-
band but the wife, who had no place to go. After
considerable effort the officers of his bank agreed
to continue the patient's salary for two months.
The patient was admitted to the Prendergast Camp,
an institution receiving at low rates patients near
Boston, who later expect to enter a state sanatorium.
The w T ife lived at home and when the time arrived
for her to be confined, was sent to a local lying-in
hospital free of charge. After she left this, her
husband insisted on coming home and refused to
consider going to a sanatorium of any kind. He
was therefore persuaded to join a " tuberculosis
class/' arrangements for outdoor sleeping were
made, and he is now carrying on the home sana-
torium treatment and doing well. In view of the
young baby and the condition of the mother, it
would have been far better if the patient had gone
to a sanatorium until entirely cured; as this was
impossible, the next best course was followed.
DRUGS AND CURES FOR CONSUMPTION; THEIR USE
All nostrums, quack remedies, widely adver-
tised " cures " for consumption, may be condemned
at once. Leave them alone, no matter how glow-
ing may be the reports you hear concerning them.
The question as to the advisability of allowing in
moderation, or occasionally, alcoholic drinks, such
as beer, ale, porter, port wine, etc., is often raised.
While in rare cases I allow or even advise patients
to take a little beer or its equivalent with their din-
ner, it happens so infrequently as to be negligible.
It is far better to leave all such things alone. They
are not " strengthening," as our friends are so apt
to assure us when they present us with bottles of
port wine, etc. The feeling of well being that re-
sults is a very temporary one and does no good.
Especially would I condemn the much overworked
" egg-nog." This has its place in acute conditions,
but not in tuberculosis.
Creosote and similar nauseating drugs not only
do no good, but much harm. I will not prescribe
them for my patients nor take them myself. Cod
liver oil and emulsions are widely advertised, if not
DRUGS AND CURES 77
as cures, as potent agents in helping to bring about a
cure for consumption. It should be borne in mind
that such preparations are merely forms of fat and
as such have some value. The taste is usually very
disagreeable. Children often do not mind taking
cod liver oil and occasionally relish it. If they are
under weight, extra fat is a good thing. There
are no special curative properties in oils and emul-
sions. Personally I have never prescribed cod liver
oil or an emulsion. If my patients need increased
fat in their diet, I prefer them to take it in cream,
butter, salads, and in other fatty foods.
Tonics, hypophosphites, etc., should only be taken
when prescribed by a physician.
Serums and vaccines, etc., likewise should be al-
lowed only under rigid competent medical super-
Inhalants of various kinds often help throat con-
ditions and relieve annoying coughs. They never
have cured tuberculosis, however.
As a general rule, the^ fewer drugs or artificial
foods or preparations of any kind are taken, the
better for the patient.
DIET IN CONSUMPTION
A good digestion is the sheet anchor in the treat-
ment of consumption. It is what is digested and
not what is eaten that counts. A tired and over-
worked stomach cannot take care of food, no mat-
ter how nourishing or attractively served.
The days of " forced feeding " are past. We
no longer try to put 20 to 30 pounds on the patient,
urge him to eat all he can and as often as he can,
and congratulate ourselves when at the end of six
months he is fat, plethoric and short-winded. This
has done much harm in the past. Each patient pre-
sents an individual problem as to diet and feeding.
As a general rule I like to have my patients put on
about ten pounds over the weight which they con-
sider normal. In fat patients it is often wise to
reduce weight ; thin ones should be given more food.
Remember that there is nothing of any specific
value as far as tuberculosis is concerned in milk or
eggs. Milk is a good nourishing food and so are
eggs, but no one with a chronic disease will benefit
by living on this diet to the exclusion of other arti-
cles of food. Eggs and milk should be taken sep-
arately, never as " egg and milk," " milk shake," or
How to make a sleeping-bag with the bed-clothes. First tuck all covers
except the top blanket under the bed-pad, and then tuck the top blanket
under the mattress. Loaned by the Journal of the Outdoor Life
DIET IN CONSUMPTION 79
" egg-nogs." I usually advise my patients to take
three square meals a day and in addition one quart
of milk. A quart of milk makes about six glasses.
These are to be scattered through the day with and
between meals. Substitute a raw tgg for a glass of
milk if you wish to, or better still, take a raw tgg
after your meals if extra food is desirable. Some
people take raw eggs without any " fixings." Most
persons break the tgg in a cup and add a little lemon
juice or salt, pepper and vinegar. Countless pa-
tients have told their doctors that they cannot pos-
sibly tolerate either milk or raw eggs. Persons un-
doubtedly do exist whose stomachs will not take
to either eggs or milk, but they are exceeding rare.
Usually it is merely a fad or a fancy on the part of
the patient and the sooner it is got rid of the better.
The question of appetite, or rather the lack of ap-
petite, is often a perplexing one. As a general
thing, it is safe to regard an appetite as a luxury
belonging to well people. A lack of appetite in
consumption is simply a symptom of the disease;
this the patient should remember and also that he
must eat even if he does so without much enjoy-
ment. This brings up a most important point in
feeding not only consumptives but all such people,
namely that a little food attractively and daintily
served will do far more good than much larger
amounts piled on the plate. The patient's friends,
nurse or attendant can spend time and energy to no
better effect than by studying this subject, prepar-
ing dainty meals and in seeing to it that each time
the patient is given his tray or sits down to the ta-
ble for a meal, the food before him is small in
amount and attractively served. Too small help-
ings are far better than too large ones. It is infin-
itely better for the patient to say, " Is this all I'm
going to get? I know I'll want some more! " than
" Oh, dear, I can't possibly eat all this!" These
may seem like small points ; they are really very im-
portant ones, however. In regard to the diet itself,
as long as it is simple and nourishing, there is little
to be said. If the patient is under weight, plenty
of fat in the form of butter, etc., is desirable. Sal-
ads of all kinds with French or mayonnaise dressing
are excellent. Fresh fruit is sometimes apt to
cause upsets and should be taken only in modera-
tion. Regularity at meals is essential.
Rest is needed for the stomach just as much as
for any other part of the body. The stomach is
simply a bag of muscle which, like the other muscles,
is apt to be flabby and weak when there is active
tuberculosis present in the body. For this reason
it is advisable for the patient to take one-half hour's
rest before and after each meal; before meals so
that the stomach is in good condition before any
food is put into it and after meals so that all the
patient's strength and energy may be devoted to
the subject in hand — that of digesting and assim-
The number of times a patient should eat depends
on circumstances and in its final analysis should be
decided by the physician. As a general rule, there
DIET IN CONSUMPTION 81
should be three regular meals a day, with light
lunches at n a.m. and 4 p.m. Such lunches
should be daintily served and may consist of a glass
of milk, broth, cocoa, a sandwich, crackers and
cheese, etc. If it is found that these lunches pre-
vent the patient from eating his regular meals, they
should be reduced or given up altogether. Be
guided by common sense and not by cast iron rules
in this as in other matters.
There is no part of the treatment of the consump-
tive in which the patient's family, nurse or attendant
can do more good and can really help more to bring
about a cure than by faithful, painstaking attention
to the details of feeding the patient.
HOW TO KEEP FROM GIVING CONSUMPTION TO
Tuberculosis is a contagious disease. It is not
so highly infectious as scarlet fever, measles, small-
pox, etc., but nevertheless, it is classified with them
as a disease " communicable and dangerous to pub-
lic health." As before stated, it is spread from one
person to another by the germ of tuberculosis in the
sputum or other discharges. How to live so as not
to endanger those about him is the great and fun-
damental lesson every consumptive must learn. The
sputum is the chief means of the spread of tuber-
culosis from one person to another. Were all the
sputum destroyed, it is safe to say that there would
be very little more consumption. Destruction of all
sputum, then, is essential. This may be done in va-
rious ways, depending on the amount which is raised
in the twenty-four hours. If this amount is slight,
paper napkins serve the purpose admirably. The
patient is provided with an ample supply of paper
napkins and a large paper bag. Each time a nap-
kin is used to collect the sputum it is placed in the
bag. At night the bag and its contents is burned.
If the patient prefers, small squares of cheesecloth
GIVING CONSUMPTION TO OTHERS 83
may be used in place of the paper napkins. This
of course is slightly more expensive. When the
amount of sputum is greater, this arrangement will
not do. In such cases, paper sputum cups should be
used and the entire cup burned when filled. These
cups vary in size and price. They are so well known
and so easily obtained as to need no description.
The patient and his family must always bear in
mind that sputum in even the smallest amount
is dangerous. Therefore, whenever the patient
coughs or sneezes, a handkerchief or napkin must
be held in front of the mouth. The patient should
kiss no one. Scrupulous cleanliness of face, mouth,
teeth and hands is necessary. Eating utensils
should be boiled after using. It is not necessary to
mark the dishes conspicuously, but it is certainly
safer for the patient to have his own knife, fork
and spoon, plate, etc. As to clothing, everything
which can stand it should be boiled. Bed clothes,
blankets, spreads, etc., should be hung outdoors in
the sun, if possible. All unnecessary floor and wall
coverings should be removed from the patient's
room, and the furniture should be of the simplest.
Before allowing others to use a room previously
occupied by a consumptive, the room should be
thoroughly cleaned. Formalin and other chemical
disinfectants are not so good as mechanical clean-
liness. Information as to how to have this form
of disinfection done, however, can be obtained from
the local or state board of health. The floor and
the walls up to at least four feet and more, if possi-
ble, should be scrubbed. To be absolutely safe the
floor might be painted and the walls painted or re-
papered. The patient's room, the sleeping porch
and piazza should be screened and every effort
made to get rid of flies, as they have been repeatedly
shown to be carriers of the germs of tuberculosis.
Constant watchfulness is the price of safety.
Well and strong adults need not seriously worry
about getting the disease, but children and young
adults, particularly if they are in any way physically
below par, are extremely susceptible. It is far
better to send all such persons away from the imme-
diate environment of a consumptive, be he ever so
careful. If conditions are such that this is impos-
sible, the greatest of care must be used.
Fear of consumptives and consumption, —
" phthisiphobia " as it is called, in its proper sense,
means a wholesome respect and dread of the disease
and a keen realization of its dangers. Carried to
excess this feeling has done much harm and caused
much unnecessary suffering. Fortunately it is grow-
ing constantly less. The person who lives and sleeps
outdoors is no longer a marked individual, because
outdoor sleeping and living has become so popular.
In addition to this, the public is beginning to real-
ize that every one is more or less exposed to the dis-
ease and that the average strong and healthy adult,
living a sensible, hygienic life, need not fear the
careful consumptive. It has been clearly demon-
strated that the standard of health of doctors,
nurses, and attendants in tuberculosis sanatoria or
resorts is higher than elsewhere and that their death
rate from consumption is lower. For these reasons
remember that while the consumptive is a sick per-
son, he is not necessarily to be shunned and ostra-
cised as is so often done.
Remember also, that the consumptive is sick ; that
he is not himself, owing to the poisonous toxins in
his system. He is apt to be fretful, irritable and
easily upset by little things. While it is often the
kindest course to be firm with the patient, the ut-
most gentleness, patience and tact are necessary at
all times. In my own experience I have not found
that the " spes phthisica," — " the consumptive's hope
and optimism/' — is so often present as gloom and
despondency, with an ever present tendency to look
on the dark side of things. This must be constantly
Remember that the consumptive, just as much as
a well person, needs a change of scenery and sur-
roundings once in a while. There should be occa-
sional shifts in the nursing force; a different room
may well be used, or the arrangement of the room
altered. Best of all is a more radical change to a
different locality or climate. In the Massachusetts
sanatoria there is a constant shifting of patients
who have stayed many months at one institution
and who seem to have reached a stationary condi-
tion, getting neither better nor worse, to another
sanatorium in a different part of the state. This
often brings about a remarkable improvement. It
is, of course, no reflection in any way on the institu-
tion the patient has left.
In the early stages of treatment, when absolute
or nearly absolute rest is indicated, a strict medical
atmosphere is an advantage. The patient must be
made to realize that he is sick, just as one with ty-
phoid fever or pneumonia is sick. This is neces-
sary in the beginning. But later on, when he has
I 111 iUI *
i til i.i
GENERAL REMARKS 87
learned how to live and to recognize symptoms and
their significance, it is well to eliminate the medical
side as much as possible. It is perfectly possible,
I believe, to keep a patient too long at Saranac Lake.
It is hard to forget the disease while there. Pa-
tients will discuss their symptoms and compare
progress with other patients, much to the disad-
vantage of each. When this stage is reached (and
the physician is the one to decide this), make some
radical change. There is a condition known to tu-
berculosis workers as " post-sanatorium neurasthe-
nia." The patient has become so introspective
while at the sanatorium that he constantly watches
every symptom and is unwilling to do anything fo
help himself in any way, although perfectly able to
do so. This is an unfortunate and quite unneces-
sary state of affairs.
Consumption is curable. This was the slogan of
our warfare against the disease ten years ago. At
the present time, while consumption in its early
stages we all know to be curable, we are more con-
servative in speaking of its curability in later stages
of the disease. Consumption is preventable always
and curable often. What constitutes a cure in con-
sumption? This is a hard question to answer defi-
nitely. In my own work, I am unwilling to call a
patient cured until he has been at least three years
without symptoms, without signs of any active dis-
ease in the lungs or elsewhere and able to lead a nor-
mal life. The term " arrested " is the safer one to
..oe. This simply means that while there may be
signs of extensive and fairly active disease in the
chest, often accompanied by cough and sputum, the
patient himself is well and strong, eats and sleeps
well, is up to his normal weight and is able to do
work of some kind. Such a person certainly is not
cured; he is liable to a relapse at any time, but on
the other hand, such a condition as this is quite com-
patible with a long and useful life.
Consumption as a social and economic problem
has at last awakened the interest of the great la-
bor organizations and of the employers of labor.
Slowly but surely the idea has crept into their minds
that it is better and cheaper to keep well by living
and working under decent conditions than it is to
get sick and then to have to pay out much money in
order to get well again. This accounts for the
great spread of the " welfare work " in factories,
stores, and other large concerns and is a great step
Rest versus exercise in the treatment of con-
sumption is a point hotly fought. Each has its
place. It is probably true, however, that too much
exercise has caused countless deaths and that it is
difficult to give a patient too much rest. If a pa-
tient is told to exercise, he is very apt to go too far
and to exercise until fatigue sets in; it is then too
late and the harm has already been done. One
must stop exercising long before actual fatigue sets
in. One of the best known authorities in this coun-
try, who has had consumption himself, has said that
if he had to take treatment all over again, he would
GENERAL REMARKS 89
go to bed and stay there for six months or more,
until all symptoms disappeared. These are wise
Outdoor sleeping is advisable in the great major-
ity of cases. There are some people, however, who
cannot do this, especially during the cold season.
They cannot be made comfortable, they do not sleep
well and there is as a result a useless waste of vital
energy. In these cases the wise physician will com-
promise and allow the patient to sleep indoors in a
room well provided with windows that are of course,
kept wide open.
A cough is considered a necessary accompaniment
to pulmonary tuberculosis. A certain amount of
coughing is almost always present, it is true, but
there is a great deal of energy wasted in useless
coughing. The avoidance of dusty streets, crowded
halls, theatres, etc., on the part of the patient will
help ; a simple oil spray inhaled well down in throat
and trachea will often prevent much coughing, while
most important of all is the mental training of the
patient not to cough except when absolutely neces-
sary. If this is done, much strength will be saved
that otherwise would have been wasted.
HINTS AND HELPS FOR TUBERCULOSIS
By Charles L. Minor, M.D.
Dr. Minor's " Hints and Helps " appeared origi-
nally in the Journal of the Outdoor Life. It is here
reprinted by the kind permission of the editor of the
Journal of the Outdoor Life. It was written pri-
marily for Dr. Minor's own patients ; hence the local
i. None at all for one week after arrival, then
ask the doctor about it.
2. Never exercise to the point of fatigue; stop
before you are tired and don't walk " on your
3. None if your afternoon temperature the day
before was over 99.5 or if your morning tempera-
ture that day is 99 °.
4. None if you are uncomfortably short of breath,
or if your pulse generally runs over a hundred.
5. None for one hour after meals.
6. None if your sputum is bloody or even pink.
HINTS AND HELPS 91
7. No hill climbing unless it is specifically ordered.
8. No pulmonary or other gymnastics or deep
breathing save when ordered.
9. No driving or horseback without permission —
walks come first.
10. If you get caught in the rain while out, and
get wet, it will not hurt you if you keep on walking,
and as soon as you get home, take an alcohol rub and
put on dry clothes.
11. In increasing your exercise never do it sud-
denly, but by small additions each day. The Greek
athlete, Milon, of Crotona, when asked how he be-
came strong enough to carry a full-grown bull up
a mountain-side, said that he accomplished it by car-
rying it every day from the day it was born, his
body thus being gradually accustomed to a strain
which at first would have been too great for it.
1. Remember that rest comes before exercise and
that the latter is only useful after the former has
so built up the system that there is a surplus of
energy to draw upon above and beyond the ordinary
demands of your body. Until the doctor finds that
you have reached that point, exercise is harmful,
and persistent, unfretting rest is best for you.
2. If the temperature is over 99.5 °, rest recum-
bent in a proper reclining chair.
3. If the temperature is over 100.5 , either be re-
cumbent on a cot outdoors or in bed.
4. If your temperature is 101 or over, go to bed
at once and let the doctor know,
1. Aim to spend a minimum of 8 to 10 hours out-
doors daily, i.e., 9-1 ; 2-6 ; 7-9. If you can do more,
so much the better. If you are in earnest about get-
ting well you will not dawdle and waste precious
time indoors that might be spent in the fresh air, by
getting late to breakfast or loafing indoors after-
wards, nor will you seize every excuse to stay in the
house. If, after returning to your home from the
sanatorium or health resort, you are of necessity in-
doors, in an office or otherwise, all day, it is im-
portant to make up for the fresh air thus lost by
sleeping out at night. When on the contrary you
are living out all day long, sleeping out at night is
not essential, if your room has two or more win-
2. If at first you cannot keep warm outdoors in
the winter, use more wraps or a hot water bag or
get up and take a short walk, or come in and warm
for a short while. Never stay outdoors while you
are chilly, but learn never to be chilly outdoors. It
is difficult if not impossible to keep w T arm outdoors
in winter if your feet are on the ground, hence you
should have a proper reclining chair. With such a
chair and proper wraps you can soon learn to keep
warm in all weathers.
3. Chairs that have concave canvas backs and hol-
low the shoulders, and stoop them, should be
HINTS AND HELPS 93 1
avoided ; a proper chair must have a broad, Hat back,
and should alter its position easily from erect to re-
cumbent. Always keep your shoulders erect whether
sitting or standing; stooped, narrow shoulders limit
your breathing space and do your lungs harm.
4. Be out of doors, but protected from the wind
and the weather, in all weathers, the only exception
being during sleet storms ; if in doubt telephone the
5. Keep your head out of the sun; it will tend to
run up your temperature. If the weather is hot in
summer it is often best to be quiet indoors for a part
of the afternoon rather than uncomfortably warm
FOOD AND EATING
1. The ideal food should be appetizing, very nu-
tritious and not too bulky.
If appetizing but not nutritious it will undernour-
ish you ;
If nutritious but not appetizing it will disgust
If too bulky, however appetizing, it will stuff you.
2. If your digestion is good, a generous mixed
diet (favoring especially red meats, eggs, milk, and
fats) is sufficient. A raw egg and a glass of milk
at 1 1 and at 4, if it does not spoil the appetite for the
next meal or unduly " stuff " you, is desirable ; but if
it upsets or overloads you stop it and ask the doctor.
If you find you often wake in the night and cannot
go to sleep again, you probably are undernourished
and should take something to eat. If you wake
more than an hour before breakfast in the morning,
don't go hungry to breakfast, but eat something.
3. If your digestion is poor the doctor will give
you special orders.
4. If your stomach feels heavy or painful after
meals, if there is belching, or if the morning urine
becomes muddy on standing, you are probably over-
eating or your digestion needs attention. Ask the
5. As to the right amount to eat, never burn too
little coal under a boiler or you won't make steam,
nor too much, else it will all go out of the chimney
in smoke and clog the boiler tubes. Learn to burn
every bit that you can properly consume — no more
and no less.
6. Be on time at meals and talk while you eat.
If it is good natured talk it will aid digestion.
7. Never eat at irregular or odd times, and eat no
candy, save directly after meals.
8. Never eat when you are tired, and never take
exercise on a full stomach; it is a sure way to pre-
vent good digestion. Therefore if tired, rest a half
hour before meals and always be quiet one hour
after. This gives your stomach time to prepare for
and to do its work. After the mid-day meal spend
one hour recumbent and silent out of doors.
9. Extra milk and eggs at 1 1 and 4 are valuable.
They are always to be taken unless stopped by doc-
tor's orders; but if they seem to overtax your stom-
ach, let the doctor know at once. Usually from two
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HINTS AND HELPS 95
to six raw eggs and from four to six glasses of milk
can be taken in twenty-four hours with benefit.
10. Eat slowly and chew well if you wish to get
the full value from your food, and always drink
your milk slowly.
11. If you have any medicines to take at meal-
time, remember other people's susceptibilities and
take them in private where you will not be seen.
12. Discourage sluggish bowels. They poison
1. In winter wear a medium weight of wool next
to your skin, unless you are accustomed to a linen
mesh. In summer, in this climate (Asheville), a
very thin wool-cotton mixture, or linen mesh, is
2. Never wear very heavy underclothing or chest
protectors. At night never sleep in a night gown or
pajamas only, unless they are of outing flannel, but
put on a light undershirt next your skin.
3. Let your shoes be stout and warm in winter.
4. In winter wrap warmly out of doors and have
an extra wrap always handy in case of a change in
5. If you get overheated and perspire change your
clothes and rub dry.
6. Never change the weight of your clothes with-
out due consideration, remembering that
" Beneath this stone, a lump of clay,
Lies Uncle Peter Dannels,
Who early in the month of May,
Took off his winter flannels."
During the first warm days of early spring it is
wise to remember the old saw, " Stick to your flan-
nels till your flannels stick to you."
In this climate you can generally wear your winter
underclothes till the middle of May or even the first
of June, and your summer ones till the 15th of No-
vember or the 1st of December.
It is often desirable to have an intermediate weight
of underclothing for spring and fall.
BATHING AND CARE OF THE SKIN
1. A healthy activity of the skin is important,
hence there should be a warm bath twice a week at
2. The skin should be hardened against catching
cold, hence a cold salt sponge taken at the bedside
immediately on rising is wise, if ordered and as or-
3. Should you be chilly or blue after your cold
bath, or if you are sick, or have a cold, or if your
sputum is pink, or if your w r aking temperature is
under 97 °, stop the bath and tell the doctor.
4. When taking a cold bath your room should not
be under 50 ; 6o° is better.
5. If you suffer from chilliness try salt and alco-
hol rubs. If you tend to perspire too freely, vinegar
and alcohol rubs.
HINTS AND HELPS 97
1. In winter it should preferably, but not neces-
sarily, face south, southeast or southwest ; in summer
usually a north, northeast or northwest room is
cooler and more comfortable.
2. Have two, or preferably more, windows and an
open fireplace, if possible. One-windowed rooms
cannot be properly ventilated unless they have a fire-
place, but can be made available by using a window
3. If a furnace flue opens into your room, keep
it shut tight.
4. No room mates should be allowed save by spe-
cial permission, and no bedfellow under any circum-
stances. Two single beds are hygienic; two people
in a double bed is unhygienic.
5. When in your room and not in bed, the room
had best be between 65 ° and 68°. When well cov-
ered up in bed no degree of cold will hurt you.
BED AND SLEEP
i. Be in bed by 10 p. m. in summer and 9 in win-
ter, and do not read in bed. Sleep not less than 8
hours no more than 10.
2. Open all windows the last thing before getting
into bed and have them closed one hour before rising.
3. As soon as accustomed to it, keep all windows
open save when hoarse or during a cold, in which
case ask advice. Find out if you sleep with your
mouth open. If so, ask the doctor. It is harmful.
4. Arrange your bed with your head near a win-
dow but do not sleep in a cross draught or with your
head in a corner.
5. Use enough covers to keep warm, but avoid
heavy bedding. Another mattress will often be bet-
ter than another blanket, and if you cannot keep
warm in bed, double mattresses with newspapers be-
tween them, or a hot bottle, or woolen leggings, or a
thin flannel sheet, or an outing flannel wrapper will
help you. As has been said earlier, always wear a
light undershirt next to the skin in bed.
1. Never forget that while amusement is neces-
sary for everyone, he who has not the grit to deny
himself pleasure for profit, to give up an amusement
however much desired, for the benefit of his health,
has not the force or the ability to succeed in any-
2. Avoid amusements which subject you to dust,
or to getting overheated, whether indoors or out;
for example : dancing, bowling or tennis.
3. Avoid exciting games, such as bridge-whist,
or poker, or those which, like chess, or an expert
game of whist, demand too much mental concen-
4. If a musician, you must not play music which
excites or deeply moves you. Light music for a
short time will not hurt you.
5. An active correspondence with relatives and
HINTS AND HELPS 99
friends is not allowed. You may write one letter a
day if your fever is not 100.5 °, but if you wish to
write more, ask the doctor. Tell your correspond-
ents not to keep you posted on all the worrying
things which happen at home. If they can't write
cheerfully, don't let them write at all.
6. Avoid amusements which keep you for a long
time indoors, or which tend to make you lose your
7. No theater or night entertainments save by
8. No shopping if avoidable, and no loafing
around town. When you walk, walk in the coun-
try. Report all trips to town.
9. If your temperature is over ioo°, no visitors
can be seen. (Excuse yourself by putting the
blame on the doctor ; he is used to being blamed and
can stand it better than you.)
10. No visiting without the doctor's permission.
CARE OF THE VOICE
1. If you are hoarse or if you have any throat
trouble, limit your speaking to the absolute mini-
mum — complete silence is best. Each spoken
word is a physical injury to a weak organ.
2. Always avoid hot, dry or dusty rooms, but es-
pecially when hoarse.
3. Never strain your voice by loud or continuous
talking or by calling to people at long distances.
4. Smoking is not allowed without special per-
mission, and inhaling under no circumstances.
5. Do not sing without telling the doctor. If
your throat is not perfectly healthy it will injure it.
COUGH AND EXPECTORATION
1. The only cough which is useful is that which
easily brings up sputum; any other is harmful to
you and irritates your respiratory tract. Therefore,
unless it comes up easily, never try to bring up some-
thing by hard coughing. By practice and will
power seventy-five per cent, of your cough can be
suppressed; therefore suppress it,
2. When you cough, always cover your mouth
with a handkerchief and not your bare hand as you
can thus soil it. If you want to know why you
should cover your mouth, hold a bright, clean look-
ing-glass in front of it while you cough once or
twice and note that it will be speckled all over with
tiny spots which came out of your mouth and lungs.
3. If talking increases your cough, lessen your
4. Always suppress your cough at table; if you
cannot, leave the table.
5. If coughing is troublesome and keeps you
awake, a dose of cough medicine at bed is usually
wise; ask the doctor. In the daytime, until you
have learned to control your cough, a dose or so
may help a weak will for awhile, but never become
dependent on it or let it take the place of your will.
6. Never spit on the ground, even out of doors,
or anywhere else, save in a sputum box or pocket
spittoon, or, where these cannot be used, in a square
HINTS AND HELPS 101
of cheese cloth, to be used but once and to be placed
after such use in a special rubber lined pocket till it
can be burned.
7. Never swallow your expectoration under any
circumstances; this can be very dangerous for you.
8. Avoid soiling your hands by rubbing them on
your lips; wash your hands often, and be careful
to clean your teeth two or three times a day.
9. Kissing may be an agreeable pastime, but until
you are thoroughly well and have no more cough or
expectoration, it should be given up. In any case,
kissing on the mouth is not wise or healthy, and
should be permanently given up, especially when
kissing little children, to whom it is very dangerous.
10. Should, by accident, the floor or anything else
become soiled by expectoration, it must be carefully
wiped up at once, with a one to twenty solution of
carbolic acid in water, and some of this solution
should be allowed to soak into the spot for an hour
or so afterwards.
11. If the above precautions are fully observed,
there is no need for anxiety as to any danger of in-
fection for yourself or others. Tuberculosis is not
easily transmissible like smallpox or scarlet fever,
and among decently cleanly people, in clean houses,
it is with difficulty handed on to others.
1. None unless ordered.
2. Stop any that will upset your stomach or spoil
your appetite, and tell the doctor at once.
3. No alcohol without special permission.
4. When taking medicines don't let other people
see you. Put yourself in their place.
1. Remember that everything which is not ex-
pressly allowed is forbidden.
2. If in doubt about anything, telephone the doc-
tor. It won't bother him and it may save you from
hurting yourself. Patients are not allowed to
weigh in the drug stores or anywhere else save the
3. If you catch cold or feel badly in any way,
telephone the doctor at once.
4. In the beginning, if you are not used to fresh
air, don't go all at once to fully open windows and
constant outdoor life in cold w r eather, but in a few
days you will be able without difficulty to live the
life strictly and with pleasure.
5. Avoid following the advice of solicitous
friends without first consulting the doctor.
6. One of the most dangerous times for you is
when you reach the point where, while not yet really
well, you feel perfectly well. Then it is that even
the most prudent are apt to forget what they have
been taught and to overdo. Remember that in this
trouble the symptoms can all cease long before the
disease is really cured, and that, excellent as it is to
feel entirely well, only a careful physical examina-
tion and a long observation can prove you so.
~ j- '
HINTS AND HELPS 103
7. When inclined to complain of the weather re-
member the old jingle, and don't.
" As a rule man's a fool,
When it's hot he wants it cool ;
When it's cool he wants it hot —
Always wants what he's not got."
8. The relation of the patient and the doctor in
this trouble is of extreme importance, and if the
results of the treatment are to be satisfactory, a
complete co-operation and confidence between them
The nature of this relationship is shown by the
following: A man once owned a steam yacht on
Lake Ontario, and was his own captain, sailing the
boat wherever he pleased without anyone's aid.
One day, however, he was obliged to go down the
St. Lawrence River to Montreal, and much against
his will, started on the trip. When he reached the
Thousand Islands he put up for the night, and as
he did so, a man on the dock asked him where he
was going. " To Montreal." " But you have no
pilot ! " " Oh, bless you, I don't need any pilot ;
I always run my boat myself and need no help."
" Well," said his interlocutor, " that does very well
on the Lakes where you have deep water, but in this
river there are rapids and hidden rocks and whirl-
pools, and you, who know nothing about them, are
pretty sure to wreck your boat." The owner there-
upon hunted up a pilot, who, after carefully inspect-
ing the hull and engines, said, " Now, please go
down and stoke the fires carefully with good coal so
as to keep up a good steam pressure, and run the
engines according to my ideas and not yours, for if
you don't, I can't possibly get you through; but
don't come into the pilothouse and bother me, for I
will have all I can do to get your boat safely through
to Montreal. When we are passed all the dangers,
I will turn her over to your own control, and you
should then be able to run it yourself under all ordi-
I. Never talk of your case or symptoms with any-
one save the doctor, and allow no one to talk of
theirs to you. Remember the saying, " I have trou-
bles of my own; go tell yours to the policeman," or
in the words of the popular hymn, " Go bury thy
sorrows, Let others be blessed, Go give them the
" What can be more unkind than to communi-
cate our low spirits to others, to go about the world
. . . poisoning the fountains of joy? Have I more
light because I have involved others in the same
gloom as myself? Is it not pleasant to see the sun
shining on the mountains, even if we have none of it
down in the valley? Oh, the littleness and the
meanness of that appetite for sympathy that will
not let us keep our sorrows to ourselves! Let us
hide our pains and sorrows. But while we hide
HINTS AND HELPS 105
them, let them also be spurs within us to urge us on
to all manner of overflowing kindness and sunny
humor to those around us." — Faber.
2. Don't Fret or Worry. Fretting or worrying
never helped anyone. If you cannot change condi-
tions, an uncomplaining acceptance of them will not
make them more hard to bear and often will reveal a
silver lining to the darkest cloud. We take the
sunshine as our right; why not accept the clouds
cheerfully? "Heroism for most of us consists in
cheerful endurance. . . . Our training for the
needs of new adventure comes from this familiar
experience of courageous bearing in the hours of
trial. Not to whimper, not to cringe, never to lis-
ten to the voice of despair, never to make our burden
an addition to the loads of other burdened men, to
follow the gleam in the darkness, to hold to God in
grief, to obey with no reason given, when the law is
made plain — he who can walk thus through the
shadowed way is arming himself for high adventure
and great service.
u Every trouble is an opportunity to win the grace
of strength. Whatever else trouble is in the world
for, it is here for this good purpose, to develop
strength. It is something which is hard to do, and
. . . strength is increased by encounter with the dif-
ficult. A world without any trouble in it would be
a place of enervation and laziness. . . . Every day
w r e are blessed with new opportunities for the de-
velopment of strength of soul." — Hodges.
3. If thinking makes you blue, use your will
power, stop thinking of that which worries you and
think of something else: its good practice for your
" Cultivate your will power. Bring the will to
bear upon your daily thinking. Has it ever oc-
curred to us that we can will our happiness ? The
proverb runs that, ' Everyone is happy who thinks
he is/ and the supreme point here is, that we cm
order our thinking. You cannot . . . regulate the
external weather by volition. The rain comes
down without asking your leave, but our mental
weather is in our own hands. We can disperse the
clouds here by an effort of the soul. The grandest
liberty we possess — and we all possess it — is that
of choosing our outlook. Let us in these matters
be masters in our own house. Why not hope in-
stead of fear and trust instead of despair? We
have not learned the art of living unless we have
learned the art of willing. The disciplined soul
thinks of possible evils just so much as is needful
for practical action and no more. It will not dwell
under cloud when it knows the way to clear sky."
4. Don't be impatient to get well ; it will only re-
tard your recovery. Nothing worth having in this
world ever comes quickly or easily, and a good cure
is often a slow one. Remember that to no half-
hearted or light-minded seeker after health will heal-
ing come ; that the results are largely dependent upon
the will power, intelligence, determination and per-
sistence of the patient; that while the doctor can
HINTS AND HELPS 107
show you the way, only YOU can walk in it. Keep
up your side of the partnership with the doctor hon-
estly ; remember that you must work hard as well as
he; be in earnest, cultivate your will power; be
hopeful; be cheerful; see the bright side, for good
spirits is the best medicine, and sunshine of a smile
can dissipate many a cloud.
" Talk happiness !
Not now and then, but every blessed day,
Even if you don't believe
The half of what you say;
There's no room here for him
Who whines as on his way he goes ;
Remember, son, the world is
Sad enough without your woes.
" Talk happiness each chance
You get — and talk it good and strong ;
Look for it in the byways
As you grimly plod along;
Perhaps it is a stranger now
Whose visit never comes —
But talk it ! Soon you'll find
That you and Happiness — are chums."
J. W. Wright.
T^HE Welfare Series is exactly what
its name implies — a series of volumes,
uniform in style of binding, and varying
in price according to number of pages,
illustrations, etc. These deal primarily with
the problems of human well-being, each from
a different standpoint or upon a different
subject. It is our purpose to develop in the
Welfare Series a source of reliable, authen-
tic and so far as possible detailed informa-
tion — in short to make each volume an
authoritative yet popular book on its partic-
ular subject. We announce for spring, 1 9 1 5,
three new titles, listed and described here,
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SMALL, MAYNARD & COMPANY, Publishers
THE INDISPENSABLE BOOK
THE FIELD OF SOCIAL SERVICE
Edited by PHILIP DAVIS
in collaboration with Maida Herman
The main object of the book is to answer the universal question :
" JUST WHAT CAN I DO IN SOCIAL WORK
AND HOW SHALL I GO ABOUT IT?"
For such inquiries, it is an indispensable text book. The table of contents :
By Philip Davis, Head Worker, Civic Service House, Boston
Background in Social Work
I The Great Watchwords of Social Work
By Robert A. Woods, Head Worker, South End House.
II The Community and The Citizen
By Jeffrey R. Bracket!, Director School for Social Work-
III The Housing Problem
By Elmer S. Forbes, Chairman Housing Committee Mass.
IV Fire Prevention
By Charles H. Cole, Adjutant General of Mass. ; formerly
Fire Commissioner of Boston
V Health and Medical Social Service
By Dr. Richard C. Cabot, Chief of West Medical Staff.
Mass. General Hospital, Boston
By Joseph Lee, President National Playground and Recrea-
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By Ernst Hermann, Supt. of Playgrounds, Newton, Mass.
VIII The New Immigration: A Problem in Education
By Frank E. Spaulding, Supt. of Schools, Minneapolis, Minn.;
Member of Immigration Commission of Mass., 1913
IX The New Immigration: A Programme
By George W. Tupper, Immigration Sec'y Y. M. C. A.
Mass. and R. I.
X Industrial Problems
By Robert G. Valentine, Industrial Counselor
THE FIELD OF SOCIAL SERVICE
The Community and the Child
XI The Volunteer and Child Labor Reform
By Richard K. Conant, Sec' y Mass. Child Labor Committee
XII The School and the Community
By Frank B. Dyer, Supt. of Schools, Boston
XIII The Vocational Movement in Education: Its Social
By Meyer Bloomfield, Director Vocation Bureau, Boston
XIV Juvenile Delinquency
By Harvey H. Baker, Justice Boston Juvenile Court
XV Public and Private Relief
By Wm. H. Pear, General Agent Boston Provident Association
XVI Social Settlement Work
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XVII Child Caring
By J. Prentice Murphy, General Sec'y Boston Children's
XVIII Organization of Charity
By Lee K. Frankel, Vice-President Metropolitan Life Insur-
XIX The Church and Social Service
By Rev. Charles F. Dole, President Twentieth Century Club
XX Religion and Social Service
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Salaried Positions in Social Work
By a Group of Experts
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By Maida Herman
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WHAT IT IS AND WHAT
TO DO ABOUT IT
JOHN B. HAWES, 2d, M.D.
Instructor in Medicine Harvard Medical School, Director Tuberculosis
Department, Assistant Visiting Physician Massachusetts
General Hospital, Secretary Massachusetts
A SUCCINCT account of tuberculosis, particularly
**■ pulmonary tuberculosis or consumption, with
special consideration of the fact that it is first of all a
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ITS LITTLE PEOPLE AND BIG PROBLEMS
By PHILIP DAVIS
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THOUGHT - STIMULATING
A Message to the
(By Seymour Deming
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"mtk Bit «0?air
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